Provider Demographics
NPI:1013705268
Name:FANNING, ELIZABETH KELLY (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KELLY
Last Name:FANNING
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:K
Other - Last Name:FANNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6359 BANDERA AVE APT C
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-3634
Mailing Address - Country:US
Mailing Address - Phone:214-601-6842
Mailing Address - Fax:
Practice Address - Street 1:3600 SHIRE BLVD STE 208
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2238
Practice Address - Country:US
Practice Address - Phone:214-556-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98246101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty