Provider Demographics
NPI:1891898474
Name:ELLIOTT, JAMES R F (MA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R F
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MA
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 1041
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-1041
Mailing Address - Country:US
Mailing Address - Phone:574-583-5656
Mailing Address - Fax:
Practice Address - Street 1:128 S ILLINOIS ST
Practice Address - Street 2:SUITE B
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-1041
Practice Address - Country:US
Practice Address - Phone:574-583-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000130A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health