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General NPI Number Information
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NPI Number | 1124367180
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Entity Type | Individual
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Provider Name | ERICA ELLIOTT LPC
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Gender | Female
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Dates
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Enumeration Date | 02/11/2013
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 10316 CAROLYN DR
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City | NEWALLA
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State | OK
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Zip | 74857-7605
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Country | US
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Telephone | 405-623-4075
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Fax |
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Provider Business Mailing Address
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Address Line | 3917 TERRY LN NE
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City | PIEDMONT
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State | OK
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Zip | 73078-9499
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Country | US
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Telephone | 405-623-4075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2050
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License Number State | OK
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