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General NPI Number Information
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NPI Number | 1245201581
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Entity Type | Individual
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Provider Name | LISA C MCELROY PHD
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Gender | Female
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 1730 SHAWNEE AVE
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City | INDIAN RIVER
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State | MI
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Zip | 49749-8705
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Country | US
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Telephone | 214-998-4888
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Fax |
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Provider Business Mailing Address
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Address Line | 1730 SHAWNEE AVE
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City | INDIAN RIVER
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State | MI
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Zip | 49749-8705
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Country | US
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Telephone | 214-998-4888
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 012579
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 34068
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License Number State | TX
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