1073039574 NPI number — ELISSA MCGILL CONSULTING SERVICES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073039574 NPI number — ELISSA MCGILL CONSULTING SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELISSA MCGILL CONSULTING SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1073039574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5518 147TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEEPING WATER
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68463-2312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-709-3140
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 S 4TH ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMWOOD
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68349-6021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-709-3140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MCGILL
Authorized Official First Name:
ELISSA
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
THERAPIST/OWNER
Authorized Official Telephone Number:
402-709-3140

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  719 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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