Provider Demographics
NPI:1467927707
Name:NELLAMATTATHIL, ELIZABETH (PHD, LCPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NELLAMATTATHIL
Suffix:
Gender:F
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 RANCH CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-4520
Mailing Address - Country:US
Mailing Address - Phone:847-946-3623
Mailing Address - Fax:
Practice Address - Street 1:1140 ARLONG PARK DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3866
Practice Address - Country:US
Practice Address - Phone:847-946-3623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014746101YP2500X
TX97364101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional