MEDICARE: ELIZABETH MEMMOTT

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	101YP2500X	Professional Counselor	E.2102327	OH
2	101YP2500X	Professional Counselor	LPC-22131	AZ
3	101YP2500X	Professional Counselor	0023657	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	N-A-1	OTHER		LICENSURE

General Provider Information

NPI Number	:	1427563923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MEMMOTT

Provider Business Mailing Address
First Line	:	1165 N WILSON AVE APT 303
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-3113
Country	:	US
Telephone Number	:	513-941-4999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1165 N WILSON AVE APT 303
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-3113
Country	:	US
Telephone Number	:	513-497-8595
Fax Number	:

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

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	04/13/2026

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Directions to “ ELIZABETH MEMMOTT ” Practice Location

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