Provider Demographics
NPI:1720867476
Name:ELLIOTT, CHAD (PLMHP, PCMSW)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PLMHP, PCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3337 N 107TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-3664
Mailing Address - Country:US
Mailing Address - Phone:531-466-1839
Mailing Address - Fax:
Practice Address - Street 1:3337 N 107TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-3664
Practice Address - Country:US
Practice Address - Phone:531-466-1839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health