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General NPI Number Information
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NPI Number | 1417492372
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Entity Type | Organization
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Legal Business Name | ELIOT DENNARD PHD
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 5502 58TH ST STE 600
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City | LUBBOCK
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State | TX
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Zip | 79414-2087
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Country | US
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Telephone | 806-513-3920
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Fax |
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Provider Business Mailing Address
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Address Line | 5502 58TH STREET, SUITE 600
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City | LUBBOCK
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State | TX
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Zip | 79414-7723
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Country | US
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Telephone | 405-821-0843
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELIZABETH ELIOT DENNARD
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Credential | PH.D.
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Telephone | 405-821-0843
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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 | 37378
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License Number State | TX
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