Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YP1600X | Pastoral Counselor |
NPI | 1316569346 |
---|---|
Provider Name | G.w. Bill Elliott Jr |
First Address | Scottsdale, AZ 85254-3959 |
Second Address | Scottsdale, AZ 85254-3959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2020 |
Last Update Date | 13/05/2020 |