1104026301 NPI number — MISS HALLY B. ELLIOT LICSW

Table of content: MISS HALLY B. ELLIOT LICSW (NPI 1104026301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104026301 NPI number — MISS HALLY B. ELLIOT LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIOT
Provider First Name:
HALLY
Provider Middle Name:
B.
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARCUS
Provider Other First Name:
HALLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104026301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 SUN TEMPLE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-288-3333
Provider Business Mailing Address Fax Number:
256-288-3334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 SUN TEMPLE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-288-3333
Provider Business Practice Location Address Fax Number:
256-288-3334
Provider Enumeration Date:
07/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)