Provider Demographics
NPI:1518399179
Name:REES, ELISA (MA LPC)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:REES
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:SHARON
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6035 WINDBREAK TRAIL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252
Mailing Address - Country:US
Mailing Address - Phone:214-518-9749
Mailing Address - Fax:
Practice Address - Street 1:1380 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247
Practice Address - Country:US
Practice Address - Phone:214-743-6184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-1285603Medicaid