MEDICARE: MRS. LISA CHRISTIAN ELLIOTT LPC-S, NCC, RPT-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2462	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	698575	OTHER		BEACON HEALTH OPTIONS

General Provider Information

NPI Number	:	1083731004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA CHRISTIAN ELLIOTT LPC-S, NCC, RPT-S

Provider Business Mailing Address
First Line	:	600 SUN TEMPLE DR
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-8643
Country	:	US
Telephone Number	:	256-288-3333
Fax Number	:	256-288-3334

Provider Business Practice Location Address
First Line	:	500 SHAE PARK RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-3597
Country	:	US
Telephone Number	:	334-270-5502
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	01/21/2021

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