Healthcare Provider Details

I. General information

NPI: 1124367180
Provider Name (Legal Business Name): ERICA ELLIOTT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10316 CAROLYN DR
NEWALLA OK
74857-7605
US

IV. Provider business mailing address

3917 TERRY LN NE
PIEDMONT OK
73078-9499
US

V. Phone/Fax

Practice location:
  • Phone: 405-623-4075
  • Fax:
Mailing address:
  • Phone: 405-623-4075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2050
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: