JOB ELLIOTT


Address: 4105 W Saint Charles Ave, Phoenix, AZ 85041
Phone: 4802335511

JOB ELLIOTT (NPI# 1932564697) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1932564697
Entity Type Individual
Full Name JOB ELLIOTT
Credential L.I.S.A.C., L.A.C.
Practice Address 4105 W Saint Charles Ave
Phoenix
AZ 85041
Mailing Address 4105 W Saint Charles Ave
Phoenix
AZ 85041-4980
Practice Telephone 4802335511
Mailing Telephone 4802335511
Enumeration Date 2015-12-23
Last Update Date 2015-12-23
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 101Y00000X Counselor LAC-15368 AZ Behavioral Health & Social Service Providers
Y 101YA0400X Counselor
Specialization: Addiction (Substance Use Disorder)
LISAC-15039 AZ Behavioral Health & Social Service Providers

Office Location

Street Address 4105 W SAINT CHARLES AVE
City PHOENIX
State AZ
Zip Code 85041

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Taxonomy Information

Taxonomy Code 101YA0400X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Addiction (Substance Use Disorder)

Taxonomy Definition

Definition to come...

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Competitor

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City PHOENIX
Zip Code 85041

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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