MEDICARE: CATHERINE JEANIENE ELLIOTT LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5081904	ID
2	101Y00000X	Counselor	5081904	ID

General Provider Information

NPI Number	:	1073460614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE JEANIENE ELLIOTT LPC

Provider Business Mailing Address
First Line	:	4227 N TAMARACK DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-4031
Country	:	US
Telephone Number	:	208-724-4773
Fax Number	:

Provider Business Practice Location Address
First Line	:	4227 N TAMARACK DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-4031
Country	:	US
Telephone Number	:	208-724-4773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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Directions to “ CATHERINE JEANIENE ELLIOTT LPC” Practice Location

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