Provider Demographics
NPI:1174750871
Name:ELLIOTT, VICTORIA LYNN (LAMFT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12405 59TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1561
Mailing Address - Country:US
Mailing Address - Phone:612-839-1791
Mailing Address - Fax:
Practice Address - Street 1:3141 FERNBROOK LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5320
Practice Address - Country:US
Practice Address - Phone:612-839-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist