Healthcare Provider Details

I. General information

NPI: 1962085969
Provider Name (Legal Business Name): ASHLEY S ELLIOTT MS, LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10685 TITAN DR
NEWBURGH IN
47630-8706
US

IV. Provider business mailing address

10685 TITAN DR
NEWBURGH IN
47630-8706
US

V. Phone/Fax

Practice location:
  • Phone: 812-499-4696
  • Fax:
Mailing address:
  • Phone: 812-499-4696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88000987A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: