Provider Demographics
NPI:1639429863
Name:ELLIOTT, MARC (LPC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:MARCUS
Other - Middle Name:
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:751 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-4473
Mailing Address - Country:US
Mailing Address - Phone:832-865-5894
Mailing Address - Fax:
Practice Address - Street 1:3722 PINEMONT DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-1220
Practice Address - Country:US
Practice Address - Phone:713-426-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66300101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health