MEDICARE: JUDY ELIZABETH ENTZENBERGER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	7420	TX
2	101YP2500X	Professional Counselor	17019	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	257758	OTHER	TX	VALUE OPTIONS
2	7449616	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1437292273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY ELIZABETH ENTZENBERGER

Provider Business Mailing Address
First Line	:	6200 SAVOY DR
Second Line	:	SUITE 505
City	:	HOUSTON
State	:	TX
Zip	:	77036-3300
Country	:	US
Telephone Number	:	713-974-6887
Fax Number	:	713-974-6965

Provider Business Practice Location Address
First Line	:	6200 SAVOY DR
Second Line	:	SUITE 505
City	:	HOUSTON
State	:	TX
Zip	:	77036-3300
Country	:	US
Telephone Number	:	713-974-6887
Fax Number	:	713-974-6965

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	09/11/2025

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