MEDICARE: DR. LISA C MCELROY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	012579	NY
2	103T00000X	Psychologist	34068	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245201581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA C MCELROY PHD

Provider Business Mailing Address
First Line	:	1730 SHAWNEE AVE
Second Line	:
City	:	INDIAN RIVER
State	:	MI
Zip	:	49749-8705
Country	:	US
Telephone Number	:	214-998-4888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 SHAWNEE AVE
Second Line	:
City	:	INDIAN RIVER
State	:	MI
Zip	:	49749-8705
Country	:	US
Telephone Number	:	214-998-4888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	03/05/2025

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