Provider Demographics
NPI:1023871191
Name:ELLIOTT, BLAYNE SIENNA (LMHC)
Entity type:Individual
Prefix:
First Name:BLAYNE
Middle Name:SIENNA
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 ELMHURST LN
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-0090
Mailing Address - Country:US
Mailing Address - Phone:386-478-9186
Mailing Address - Fax:
Practice Address - Street 1:103 N ORANGE ST UNIT E
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7027
Practice Address - Country:US
Practice Address - Phone:386-222-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2025-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health