Provider Demographics
NPI:1164022018
Name:ELWIN, JALEESA
Entity type:Individual
Prefix:
First Name:JALEESA
Middle Name:
Last Name:ELWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22001 NORTHPARK DR STE 400
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3809
Mailing Address - Country:US
Mailing Address - Phone:281-223-5300
Mailing Address - Fax:
Practice Address - Street 1:22001 NORTHPARK DR STE 400
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3809
Practice Address - Country:US
Practice Address - Phone:281-223-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst