Provider Demographics
NPI:1245201581
Name:MCELROY, LISA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:C
Last Name:MCELROY
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 1:316 BEECHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5303
Mailing Address - Country:US
Mailing Address - Phone:214-918-1669
Mailing Address - Fax:
Practice Address - Street 1:316 BEECHWOOD LN
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-5303
Practice Address - Country:US
Practice Address - Phone:214-918-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012579103T00000X
TX34068103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01676333Medicaid
NYCC3789Medicare ID - Type Unspecified
NY01676333Medicaid