MEDICARE: CHRISTINA NICOLE ELANDARY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	84991	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	46419	TX

General Provider Information

NPI Number	:	1215602321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA NICOLE ELANDARY

Provider Business Mailing Address
First Line	:	PO BOX 101511
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76185-1511
Country	:	US
Telephone Number	:	972-467-2102
Fax Number	:

Provider Business Practice Location Address
First Line	:	3226 COLLINSWORTH ST STE F
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6528
Country	:	US
Telephone Number	:	972-467-2102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	08/11/2021

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Directions to “ CHRISTINA NICOLE ELANDARY ” Practice Location

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