Provider Demographics
NPI:1164906830
Name:ELY, MISTY PEARL (EDD, LCSW, MHPS, PSS)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:PEARL
Last Name:ELY
Suffix:
Gender:F
Credentials:EDD, LCSW, MHPS, PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 ROCKFIELD CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-5435
Mailing Address - Country:US
Mailing Address - Phone:817-909-2130
Mailing Address - Fax:
Practice Address - Street 1:2408 ROCKFIELD CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-5435
Practice Address - Country:US
Practice Address - Phone:817-970-9149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical