Healthcare Provider Details

I. General information

NPI: 1740547801
Provider Name (Legal Business Name): ALICIA M ELLIOTT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6380 LBJ FWY STE 299
DALLAS TX
75240-6439
US

IV. Provider business mailing address

6380 LBJ FWY STE 299
DALLAS TX
75240-6439
US

V. Phone/Fax

Practice location:
  • Phone: 972-755-0996
  • Fax: 972-386-5229
Mailing address:
  • Phone: 972-755-0996
  • Fax: 972-386-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number66266
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number66266
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number66266
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: