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General NPI Number Information
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NPI Number | 1396502043
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Entity Type | Organization
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Legal Business Name | JILLIAN ELLIOTT THERAPY LLC
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 801 N WEBER ST STE 200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-5927
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Country | US
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Telephone | 304-633-9412
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Fax |
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Provider Business Mailing Address
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Address Line | 912 MESA CREEK DR
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City | MONUMENT
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State | CO
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Zip | 80132-7432
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Country | US
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Telephone | 304-633-9412
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | JILLIAN ELLIOTT
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Credential | LCSW
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Telephone | 304-633-9412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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