Provider Demographics
NPI:1649338583
Name:ELLIOTT, MICHAEL CODY (LPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CODY
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 AIRPORT RD
Mailing Address - Street 2:P O BOX 747
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160
Mailing Address - Country:US
Mailing Address - Phone:972-524-4159
Mailing Address - Fax:
Practice Address - Street 1:1400 COLLEGE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482
Practice Address - Country:US
Practice Address - Phone:903-885-8611
Practice Address - Fax:903-439-1080
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional