Provider Demographics
NPI:1619263100
Name:ELLIOTT, ALLIRA M
Entity Type:Individual
Prefix:MRS
First Name:ALLIRA
Middle Name:M
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 MALLARD CIR
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-8989
Mailing Address - Country:US
Mailing Address - Phone:850-501-2815
Mailing Address - Fax:
Practice Address - Street 1:2918 MALLARD CIR
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-8989
Practice Address - Country:US
Practice Address - Phone:850-501-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor