ELISSA D WILBURN PHD
NPI 1669969861
Psychologist - Clinical in Little Rock, AR

Q: What is Elissa Wilburn's NPI number?

The NPI number for Elissa Wilburn is 1669969861. It was assigned to this individual provider in the NPPES registry on April 13, 2018. The provider is also known as Elissa H Dougherty Phd.

Q: What is Elissa Wilburn's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Elissa Wilburn was last updated on January 31, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 13, 2018PECOS Enrolled

1210 WOLFE ST, LITTLE ROCK, AR 72202(501) 364-5150(501) 364-6966 Get Directions Write a Review

NPPES record last updated: January 31, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 31, 2022, Feb 17, 2021, Apr 13, 2018 (3 updates tracked since 2018).

On this page

About Elissa D Wilburn Phd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ELISSA D WILBURN PHD (NPI 1669969861) is an individual clinical provider in Little Rock, Arkansas, licensed in Arkansas (202163) and active in the NPI registry since April 2018. She is enrolled in Medicare PECOS and maintains a secondary practice location in Little Rock.

NPPES Registry Identity

NPI1669969861

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameELISSA D WILBURNCredential: PHD

Location Address1210 WOLFE STLittle Rock, AR 72202-4618

Mailing Address4301 W Markham St # 783Little Rock, AR 72205-7101 · (501) 686-8000 · Fax (501) 526-6562

Phone(501) 364-5150

Fax(501) 364-6966

Sole ProprietorNo

Enumeration DateApril 13, 2018

Last NPPES UpdateJanuary 31, 20223 updates tracked since enumeration

NPPES CertifiedJanuary 31, 2022

✔ NPI 1669969861 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Licenses✔ Licensed in AR · 202163✔ Licensed in AR · 19-31AP-PL

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

1210 WOLFE ST, Little Rock, AR 72202

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Other Names 1

Former Name (1)Elissa H Dougherty Phd

Secondary Practice Location 1

Location 14301 W Markham St # 654Little Rock, AR 72205-7101 · Phone (501) 364-1992

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Arkansas Blue Cross and Blue Shield, Health Advantage, Octave.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Elissa D Wilburn Phd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 72202 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$157.74 typical visit price

range $51.36 – $157.74

Typical copayment $39.43 (range $12.84 – $39.43)

Most-billed visit code 99205

Established Patient

$91.63 typical visit price

range $16.16 – $128.77

Typical copayment $22.90 (range $4.04 – $32.19)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MELISSA LEE WRIGHT PSYD

Psychologist (Clinical)