Provider Demographics
NPI:1336188788
Name:ELLIOTT PSYCHIATRIC SERVICES, PLLC
Entity Type:Organization
Organization Name:ELLIOTT PSYCHIATRIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-219-0090
Mailing Address - Street 1:851 CORPORATE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-5428
Mailing Address - Country:US
Mailing Address - Phone:859-219-0090
Mailing Address - Fax:859-219-0339
Practice Address - Street 1:851 CORPORATE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-5428
Practice Address - Country:US
Practice Address - Phone:859-219-0090
Practice Address - Fax:859-219-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6395Medicare ID - Type Unspecified
KYX50329Medicare UPIN