Provider Demographics
NPI:1245413863
Name:ELLIOTT, CARISSA LYNN (LMHP)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:LYNN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 N MOREHEAD ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2135
Mailing Address - Country:US
Mailing Address - Phone:308-430-4273
Mailing Address - Fax:
Practice Address - Street 1:127 W 2ND ST STE 201
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2883
Practice Address - Country:US
Practice Address - Phone:308-430-4273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026164200Medicaid