=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013645613
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELLIOTT COUNSELING AND TRAINING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2022
-----------------------------------------------------
Last Update Date | 08/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29710 US HIGHWAY 281 N STE 205
-----------------------------------------------------
City | BULVERDE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78163-3289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-844-3286
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1303 DAVID CROCKETT
-----------------------------------------------------
City | FISCHER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78623-2103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-844-3286
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | MS. KRISTI ELLIOTT
-----------------------------------------------------
Credential | MS, LPC-S
-----------------------------------------------------
Telephone | 281-844-3286
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------