Individual
MYA ANTONYA ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
800 ZORN AVE, LOUISVILLE, KY 40206-1433
(502) 287-4000
Mailing address
3700 FREESTONE CT, LOUISVILLE, KY 40218-2793
(502) 424-1659
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
CSW00001019
KY
Other
Enumeration date
07/08/2026
Last updated
07/08/2026
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