Provider Demographics
NPI:1871550731
Name:ELLIOTT, TAUSHA BRADSHAW (LPC)
Entity type:Individual
Prefix:MRS
First Name:TAUSHA
Middle Name:BRADSHAW
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:TAUSHA
Other - Middle Name:LEA
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:6010 E HWY 191
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-5070
Mailing Address - Country:US
Mailing Address - Phone:432-552-0230
Mailing Address - Fax:432-552-0333
Practice Address - Street 1:6010 E HWY 191
Practice Address - Street 2:SUITE 120
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5070
Practice Address - Country:US
Practice Address - Phone:432-552-0230
Practice Address - Fax:432-552-0333
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3704LCOtherBLUECROSSBLUESHIELD
TX10811OtherLICENSED PROF. COUNSELOR