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NPI Code Detail

MEDICARE: ROLLIE B. ELIZONDO PSYCHOTHERAPY & COUNSELING PLLC

MEDICARE: ROLLIE B. ELIZONDO PSYCHOTHERAPY & COUNSELING PLLC
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1366064073
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROLLIE B. ELIZONDO PSYCHOTHERAPY & COUNSELING PLLC
Provider Business Mailing Address
First Line : 310 SUL ROSS ST
Second Line :
City : HOUSTON
State : TX
Zip : 77006-5116
Country : US
Telephone Number : 713-364-6755
Fax Number :
Provider Business Practice Location Address
First Line : 310 SUL ROSS ST
Second Line :
City : HOUSTON
State : TX
Zip : 77006-5116
Country : US
Telephone Number : 713-494-0502
Fax Number :
Authorized Official
Title or Position : THERAPIST
Name : MR. ROLLIE ELIZONDO JR.
Credential : LCSW
Telephone Number : 713-364-6755
Provider Enumeration Date : 05/15/2020
Last Update Date : 12/07/2020

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