Provider Demographics
NPI:1891286183
Name:SILLERS, ELISE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:SILLERS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 ROUND TABLE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1827
Mailing Address - Country:US
Mailing Address - Phone:512-350-7559
Mailing Address - Fax:
Practice Address - Street 1:10010 ANDERSON MILL RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2127
Practice Address - Country:US
Practice Address - Phone:512-257-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74812101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health