Provider Demographics
NPI:1225507098
Name:ELI, SHLENE (LPC)
Entity Type:Individual
Prefix:
First Name:SHLENE
Middle Name:
Last Name:ELI
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 1:1513 HOLLY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0910
Mailing Address - Country:US
Mailing Address - Phone:833-639-3290
Mailing Address - Fax:
Practice Address - Street 1:15632 STATE HIGHWAY 110 S STE 23
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-5524
Practice Address - Country:US
Practice Address - Phone:833-639-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty