Provider Demographics
NPI:1114753696
Name:MONTENEGRO, ELMA ELIZABETH (LPC)
Entity type:Individual
Prefix:
First Name:ELMA
Middle Name:ELIZABETH
Last Name:MONTENEGRO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 NOCONA DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-7254
Mailing Address - Country:US
Mailing Address - Phone:469-667-4599
Mailing Address - Fax:
Practice Address - Street 1:4625 COIT RD STE 240
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4927
Practice Address - Country:US
Practice Address - Phone:972-810-7241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty