Healthcare Provider Details

I. General information

NPI: 1003005273
Provider Name (Legal Business Name): SHERI ANN ELLIOTT MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 LONG DR STE C
SHERIDAN WY
82801-3282
US

IV. Provider business mailing address

909 LONG DR STE C
SHERIDAN WY
82801-3282
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-8958
  • Fax: 307-672-8950
Mailing address:
  • Phone: 307-672-8958
  • Fax: 307-672-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1062
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1062
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1062
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: