Individual
ELHAM ELLIE MANDAVI BERENJI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
121 BRUNNEN WAY, GEORGETOWN, TX 78626-2620
(210) 717-6155
Mailing address
121 BRUNNEN WAY, GEORGETOWN, TX 78626-2620
(210) 717-6155
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15161
TX
101YM0800X
Mental Health Counselor
82942
TX
Other
Enumeration date
11/30/2020
Last updated
11/30/2020
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