Provider Demographics
NPI:1760718159
Name:ELLIOTT, MAGGIE KRISTEN (LBSW)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:KRISTEN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4033
Mailing Address - Country:US
Mailing Address - Phone:832-527-3721
Mailing Address - Fax:972-369-7729
Practice Address - Street 1:2609 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4033
Practice Address - Country:US
Practice Address - Phone:832-527-3721
Practice Address - Fax:972-369-7729
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51033171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX51033OtherLBSW