Active NPI
Elmer J. Lizama
- Clinical Psychologist
- Dallas, TX
National Provider Identifier
1477583151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 22747
- Practice address
- 8059 Scyene Cir
Dallas, TX 75227-5534 - Phone
- (800) 257-8715
- Fax
- (800) 819-1655
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 22747 | TX | Primary |
Addresses
Primary practice location
8059 Scyene Cir
Dallas, TX 75227-5534
Mailing address
10226 Deermont TRL
Dallas, TX 75243-2525
Phone (972) 644-6398
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 116012904 | Medicaid | TX | |
| 680007553 | Other | TX | RAIL ROAD |
| 116012902 | Medicaid | TX | |
| 116012903 | Medicaid | TX | |
| 86075A | Other | TX | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22747 | TX | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1477583151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10226 DEERMONT TRL",
"city": "DALLAS",
"state": "TX",
"postal_code": "752432525",
"telephone_number": "972-644-6398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8059 SCYENE CIR",
"city": "DALLAS",
"state": "TX",
"postal_code": "752275534",
"telephone_number": "800-257-8715",
"fax_number": "800-819-1655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIZAMA",
"first_name": "ELMER",
"middle_name": "J.",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-05",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "22747",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "116012904",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD",
"identifier": "680007553",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "116012902",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "116012903",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "86075A",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.