Basic Information
Provider Information | |||||||||
NPI: | 1669962437 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ELMY | ||||||||
FirstName: | MARGARET | ||||||||
MiddleName: | K | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | BCBA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7500 SAN FELIPE ST STE 990 | ||||||||
Address2: |   | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770631708 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2818263382 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 343 FOUNTAINS PKWY STE 201 | ||||||||
Address2: |   | ||||||||
City: | FAIRVIEW HEIGHTS | ||||||||
State: | IL | ||||||||
PostalCode: | 622082170 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6185151441 | ||||||||
FaxNumber: | 6185514711 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/16/2018 | ||||||||
LastUpdateDate: | 07/07/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/01/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X |   | IL | Y |   | Behavioral Health & Social Service Providers | Behavioral Analyst |   |
No ID Information.