Provider Demographics
NPI:1669630232
Name:MESSARRA, ELAINE MARY (MS LPC)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARY
Last Name:MESSARRA
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E MOCKINGBIRD LN STE 275
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2189
Mailing Address - Country:US
Mailing Address - Phone:361-575-4351
Mailing Address - Fax:361-575-1497
Practice Address - Street 1:1501 E MOCKINGBIRD LN STE 275
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2189
Practice Address - Country:US
Practice Address - Phone:361-575-4351
Practice Address - Fax:361-575-1497
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12798101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health