Provider Demographics
NPI:1346971538
Name:MCELWEE, LILLY-ROSE F (BS, RBT)
Entity Type:Individual
Prefix:
First Name:LILLY-ROSE
Middle Name:F
Last Name:MCELWEE
Suffix:
Gender:F
Credentials:BS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4983 WOOD BROOK CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-1033
Mailing Address - Country:US
Mailing Address - Phone:574-304-9072
Mailing Address - Fax:
Practice Address - Street 1:1079 SPACE CENTER DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-3612
Practice Address - Country:US
Practice Address - Phone:855-754-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-124597106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician