Provider Demographics
NPI:1780860874
Name:PINNEY, ELISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:
Last Name:PINNEY
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 1:1111 HERRING AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3642
Mailing Address - Country:US
Mailing Address - Phone:254-750-1271
Mailing Address - Fax:245-750-1358
Practice Address - Street 1:1111 HERRING AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3642
Practice Address - Country:US
Practice Address - Phone:254-750-1271
Practice Address - Fax:245-750-1358
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23571103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist