Basic Information
| Provider Information | |||||||||
| NPI: | 1750923975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELLIOTT | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | MA, NCC, LCPC-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 LAKES LN | ||||||||
| Address2: | |||||||||
| City: | ELLSWORTH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046053339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076109244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 52 CHRISTIAN RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ELLSWORTH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046053210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076675357 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2019 | ||||||||
| LastUpdateDate: | 05/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | XL5368 | ME | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.