Individual
MR. JEFFREY BRYAN ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.C.
Contact information
Practice address
4824 E BASELINE RD, SUITE 124, MESA, AZ 85206-4676
(602) 550-2073
Mailing address
4824 E BASELINE RD, SUITE 124, MESA, AZ 85206-4676
(602) 550-2073
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-10063
AZ
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-10173
AZ
Other
Enumeration date
07/30/2007
Last updated
07/30/2007
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