Provider Demographics
NPI:1659429785
Name:ELIJAH, MARY E (MED, LPC, RPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:ELIJAH
Suffix:
Gender:F
Credentials:MED, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 GRANT RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4400
Mailing Address - Country:US
Mailing Address - Phone:832-334-9659
Mailing Address - Fax:
Practice Address - Street 1:10601 GRANT RD
Practice Address - Street 2:SUITE 114
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4400
Practice Address - Country:US
Practice Address - Phone:832-334-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16298101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX473013OtherVALUE OPTIONS