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General NPI Number Information
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NPI Number | 1043788466
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Entity Type | Individual
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Provider Name | LISA ELLERMAN MED, LPC
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Gender | Female
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Dates
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Enumeration Date | 11/03/2018
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 1111 BELT LINE RD
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City | GARLAND
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State | TX
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Zip | 75040-3299
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Country | US
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Telephone | 972-961-7078
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Fax |
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Provider Business Mailing Address
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Address Line | 8114 SPINNAKER CV
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City | ROWLETT
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State | TX
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Zip | 75089-2526
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Country | US
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Telephone | 972-523-4964
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Fax | 214-299-9146
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 75916
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 75916
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 75916
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License Number State | TX
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