Provider Demographics
NPI:1669691580
Name:ELLIOTT, KRISTEN JOY (MA, LICDC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JOY
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MA, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6797 N HIGH ST
Mailing Address - Street 2:STE. 155
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2533
Mailing Address - Country:US
Mailing Address - Phone:614-846-0305
Mailing Address - Fax:614-846-1059
Practice Address - Street 1:6797 N HIGH ST
Practice Address - Street 2:STE. 155
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2533
Practice Address - Country:US
Practice Address - Phone:614-846-0305
Practice Address - Fax:614-846-1059
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH933774101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)