Provider Demographics
NPI:1538713854
Name:ELLIOTT, ELISSA (LCMHC)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 REED ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-2726
Mailing Address - Country:US
Mailing Address - Phone:603-512-6643
Mailing Address - Fax:
Practice Address - Street 1:66 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3506
Practice Address - Country:US
Practice Address - Phone:603-270-9220
Practice Address - Fax:603-232-1376
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2150101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health