Provider Demographics
NPI:1417492372
Name:ELIOT DENNARD PHD
Entity Type:Organization
Organization Name:ELIOT DENNARD PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ELIOT
Authorized Official - Last Name:DENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-821-0843
Mailing Address - Street 1:5502 58TH STREET, SUITE 600
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-7723
Mailing Address - Country:US
Mailing Address - Phone:405-821-0843
Mailing Address - Fax:
Practice Address - Street 1:5502 58TH ST STE 600
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-2087
Practice Address - Country:US
Practice Address - Phone:806-513-3920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37378103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty