Provider Demographics
NPI:1760089056
Name:ELLIOTT, PAIGE TAYLOR
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:TAYLOR
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 6TH AVENUE EAST N
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4124
Mailing Address - Country:US
Mailing Address - Phone:510-207-4237
Mailing Address - Fax:
Practice Address - Street 1:420 WINDWARD WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2680
Practice Address - Country:US
Practice Address - Phone:510-207-4237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT70860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional