Provider Demographics
NPI:1750757993
Name:ELLIOTT, JENIFFER (LCPC)
Entity type:Individual
Prefix:
First Name:JENIFFER
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1953
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-1953
Mailing Address - Country:US
Mailing Address - Phone:406-781-3087
Mailing Address - Fax:406-866-0330
Practice Address - Street 1:410 CENTRAL AVE STE 512
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3128
Practice Address - Country:US
Practice Address - Phone:406-781-3087
Practice Address - Fax:406-866-0330
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7333101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0422188Medicaid