Provider Demographics
NPI:1184689440
Name:LANSFORD, ELAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELAYNE
Middle Name:
Last Name:LANSFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SOUTH MOPAC EXPY
Mailing Address - Street 2:BLDG I, SUITE 480
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5787
Mailing Address - Country:US
Mailing Address - Phone:512-329-0951
Mailing Address - Fax:512-329-0231
Practice Address - Street 1:901 SOUTH MOPAC EXPRESSWAY
Practice Address - Street 2:BLDG I, SUITE 480
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5787
Practice Address - Country:US
Practice Address - Phone:512-329-0951
Practice Address - Fax:512-329-0231
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2744103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX067EMedicare ID - Type Unspecified