Provider Demographics
NPI:1063043420
Name:ELEPHANT CLINIC LTD.
Entity Type:Organization
Organization Name:ELEPHANT CLINIC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:PACKIAM
Authorized Official - Last Name:ALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-860-4813
Mailing Address - Street 1:8 UNF DR # 221
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7699
Mailing Address - Country:US
Mailing Address - Phone:904-860-4813
Mailing Address - Fax:
Practice Address - Street 1:8 UNF DR # 221
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7699
Practice Address - Country:US
Practice Address - Phone:904-860-4813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health