Mark Elizondo, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

54312 Issued in TX

Practice address

2121 W Spring Creek Pkwy Ste 204
Plano, TX 75023-4539

Phone

(817) 917-2426

NPI assigned

Jun 3, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422489600000",
    "number": "1124431671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9962 WAKE BRIDGE DR",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750354733",
            "telephone_number": "817-917-2426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 W SPRING CREEK PKWY STE 204",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750234539",
            "telephone_number": "817-917-2426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIZONDO",
        "first_name": "MARK",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-03",
        "last_updated": "2015-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "54312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elite Prime Life
• Elite Spine Assist, PLLC
• Elite Surgery Center
• Elizabeth Eversull MD
• Elizabeth Kerner, M.D., P.a.
• Ahmed Elkaialy, MD
• Lisa McGillvary Elkin
• Amyra Elkins
• Ellen Fan M D P a
• John Ellett, LPO

• Clinical Social Worker in Plano, TX
• Providers in Plano, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.