Provider Demographics
NPI:1881464006
Name:ELLIOTT, HEIDI LOUISE (LPC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LOUISE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 E KILLARNEY PL
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1811
Mailing Address - Country:US
Mailing Address - Phone:316-371-9545
Mailing Address - Fax:
Practice Address - Street 1:2501 E CENTRAL AVE STE 2
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3344
Practice Address - Country:US
Practice Address - Phone:316-684-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04577101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor