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General NPI Number Information
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NPI Number | 1619401353
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Entity Type | Individual
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Provider Name | ELLIOT WITHERSPOON LPC
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Gender | Female
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 6377 NE EVERGREEN PKWY
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City | HILLSBORO
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State | OR
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Zip | 97124-6014
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Country | US
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Telephone | 503-773-0151
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Fax |
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Provider Business Mailing Address
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Address Line | 1 EMBARCADERO CTR STE 1900
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-3723
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Country | US
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Telephone | 415-658-6791
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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 | C4226
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License Number State | OR
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