Provider Demographics
NPI:1821596321
Name:HAKIM, ELLIE PROSSER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLIE
Middle Name:PROSSER
Last Name:HAKIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ELLIE
Other - Middle Name:CHRISTINE
Other - Last Name:PROSSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-0624
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:5323 HARRY HINES BLVD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9312
Practice Address - Country:US
Practice Address - Phone:214-645-8680
Practice Address - Fax:214-648-3914
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32773103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist