Provider Demographics
NPI:1669629051
Name:ELLIOTT, JOSHUA A (LPCC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:A
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2892 PEAKS MILL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8876
Mailing Address - Country:US
Mailing Address - Phone:859-536-5932
Mailing Address - Fax:859-201-1329
Practice Address - Street 1:114 DENNIS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-536-5932
Practice Address - Fax:859-201-1329
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY164143101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherTAX ID
KY7100344790Medicaid