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General NPI Number Information
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NPI Number | 1093890139
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Entity Type | Individual
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Provider Name | LISA M ELLIOTT PHD
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 3201 TEASLEY LN STE 202
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City | DENTON
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State | TX
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Zip | 76210-8302
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Country | US
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Telephone | 940-484-4311
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Fax | 940-484-5075
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Provider Business Mailing Address
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Address Line | PO BOX 99213
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City | FORT WORTH
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State | TX
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Zip | 76199-0213
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Country | US
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Telephone | 682-885-4871
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Fax | 682-885-3939
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 25244
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 25244
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License Number State | TX
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