MEDICARE: ELIZABETH GREER CULBERTSON I LCSW

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	101YM0800X	Mental Health Counselor	58614	TX

General Provider Information

NPI Number	:	1528535945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH GREER CULBERTSON I LCSW

Provider Business Mailing Address
First Line	:	595 ROUND ROCK WEST DR STE 501
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5032
Country	:	US
Telephone Number	:	501-554-1176
Fax Number	:

Provider Business Practice Location Address
First Line	:	595 ROUND ROCK WEST DR STE 501
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5032
Country	:	US
Telephone Number	:	501-554-1176
Fax Number	:

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

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	10/24/2018

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