Individual
MS. ELIZABETH PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1620 GREEN MEADOW LN, SPRING BRANCH, TX 78070-5319
(830) 822-2361
Mailing address
1620 GREEN MEADOW LN, SPRING BRANCH, TX 78070-5319
(830) 822-2361
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12449
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185727801
—
TX
Enumeration date
11/12/2007
Last updated
08/26/2013
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