Healthcare Provider Details

I. General information

NPI: 1407775281
Provider Name (Legal Business Name): JOSHUA SERLE ELLIOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E ROOSEVELT RD STE 8
WHEATON IL
60187-6850
US

IV. Provider business mailing address

714 W ROOSEVELT RD APT C8
WHEATON IL
60187-4862
US

V. Phone/Fax

Practice location:
  • Phone: 630-588-1201
  • Fax:
Mailing address:
  • Phone: 682-214-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: