Doctor Name: | MS. ELIZABETH PROVOST |
NPI Number: | 1871773440 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 12449 |
Business Practice Address: | 1620 Green Meadow Ln Spring Branch, TX - 780705319 |
Business Phone Number: | 8308222361 |
Business Fax Number: | |
Mailing Address: | 1620 Green Meadow Ln, SPRING BRANCH |
State: | TX |
Postal Code: | 780705319 |
Phone Number: | 8308222361 |
Fax Number: | |
NPI Enumeration Date: | 11/12/2007 |
NPI Last Update Date: | 08/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 12449 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |