Provider Demographics
NPI:1124791140
Name:ELLIOT, ALEXANDRA LIN (PHD, LP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LIN
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 N QUINLAN PARK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-6088
Mailing Address - Country:US
Mailing Address - Phone:512-506-1980
Mailing Address - Fax:512-387-9734
Practice Address - Street 1:2900 N QUINLAN PARK RD STE 250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-6088
Practice Address - Country:US
Practice Address - Phone:512-506-1980
Practice Address - Fax:512-387-9734
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38457103T00000X, 103TC0700X, 103TC2200X, 103TR0400X, 103TS0200X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool