Basic Information
Provider Information
NPI: 1003005273
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ELLIOTT
FirstName: SHERI
MiddleName: ANN
NamePrefix: MRS.
NameSuffix:  
Credential: MS, LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 909 LONG DR STE C
Address2:  
City: SHERIDAN
State: WY
PostalCode: 828013282
CountryCode: US
TelephoneNumber: 3076728958
FaxNumber: 3076728950
Practice Location
Address1: 909 LONG DR STE C
Address2:  
City: SHERIDAN
State: WY
PostalCode: 828013282
CountryCode: US
TelephoneNumber: 3076728958
FaxNumber: 3076728950
Other Information
ProviderEnumerationDate: 10/23/2007
LastUpdateDate: 12/30/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X1062WYN Behavioral Health & Social Service ProvidersCounselor 
101YM0800X1062WYN Behavioral Health & Social Service ProvidersCounselorMental Health
101YP2500X1062WYY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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