Provider Demographics
NPI:1881227429
Name:ELLIOTT, EMILY KATHERINE CRUSE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHERINE CRUSE
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:PO BOX 65443
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-0443
Mailing Address - Country:US
Mailing Address - Phone:515-423-0358
Mailing Address - Fax:515-355-3493
Practice Address - Street 1:420 49TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-2510
Practice Address - Country:US
Practice Address - Phone:515-423-0358
Practice Address - Fax:515-355-3493
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106763101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health