Provider Demographics
NPI:1457493330
Name:LEMMER, ELAINE FANNIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:FANNIE
Last Name:LEMMER
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 1:1191 N WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5108
Mailing Address - Country:US
Mailing Address - Phone:214-789-3334
Mailing Address - Fax:972-775-5667
Practice Address - Street 1:1191 N WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5108
Practice Address - Country:US
Practice Address - Phone:214-789-3334
Practice Address - Fax:972-775-5667
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32580103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123004OtherVALUE OPTIONS
TX55354OtherCIGNA
TX65LVOtherBCBSTX
TX7520634OtherAETNA
TX55354OtherCIGNA