Elizabeth Koutrelakos

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-1192 Issued in WY

Practice address

320 E Broadway Ave
Jackson, WY 83001

Phone

(307) 200-9882

NPI assigned

May 7, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mental Health & Recovery Services of Jackson Hole

  • Case Manager/Care Coordinator
  • Jackson, WY
  • NPI 1548137508
  NPD (past)
• Mental Health & Recovery Services of Jackson Hole

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jackson, WY
  • NPI 1578635462
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568160000000",
    "number": "1154986958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 E NEZ PERCE RD",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830019382",
            "telephone_number": "307-200-9882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 E BROADWAY AVE",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83001",
            "telephone_number": "307-200-9882"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 E Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "WY",
            "postal_code": "83001",
            "country_code": "US",
            "telephone_number": "307-200-9882",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOUTRELAKOS",
        "first_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-07",
        "last_updated": "2019-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WY",
            "license": "LCSW-1192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah M Kline, LPC
• Anne Kathleen Knudson, PT, DPT
• Tom N Kohlhardt, DDS
• Grant Kollenborn
• Jessica J Kotnour, PT
• Bonnie Christine Kovacs, O.D.
• Kristin L Wright NP, LLC
• Lindley Kunce, PPC
• L.F.Kroner III MD PC
• La Familia Counseling Services

• Clinical Social Worker in Jackson, WY
• Providers in Jackson, WY by specialty
• Clinical Social Worker in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.