1669629051 NPI number — MR. JOSHUA A ELLIOTT LPCC

Table of content: MR. JOSHUA A ELLIOTT LPCC (NPI 1669629051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669629051 NPI number — MR. JOSHUA A ELLIOTT LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIOTT
Provider First Name:
JOSHUA
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
M

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:
1669629051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2892 PEAKS MILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40511-8876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-536-5932
Provider Business Mailing Address Fax Number:
859-201-1329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 DENNIS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-536-5932
Provider Business Practice Location Address Fax Number:
859-201-1329
Provider Enumeration Date:
08/27/2008

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: 101YM0800X , with the licence number:  164143 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 164143 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 610661458 . This is a "TAX ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100344790 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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