Provider Demographics
NPI:1104369628
Name:ELMAZI, MERITA (LPC)
Entity Type:Individual
Prefix:
First Name:MERITA
Middle Name:
Last Name:ELMAZI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 HEMPHILL ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4706
Mailing Address - Country:US
Mailing Address - Phone:817-569-5900
Mailing Address - Fax:817-569-5998
Practice Address - Street 1:1527 HEMPHILL ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4706
Practice Address - Country:US
Practice Address - Phone:817-569-5900
Practice Address - Fax:817-569-5998
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71883101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional