Provider Demographics
NPI:1508488776
Name:REDFORD, ELEN (CRC, LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:ELEN
Middle Name:
Last Name:REDFORD
Suffix:
Gender:F
Credentials:CRC, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 E STANDIFER ST
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-5853
Mailing Address - Country:US
Mailing Address - Phone:972-838-8200
Mailing Address - Fax:
Practice Address - Street 1:6401 ELDORADO PKWY STE 304
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6199
Practice Address - Country:US
Practice Address - Phone:972-656-9412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14739101YA0400X
TX79078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)