Healthcare Provider Details

I. General information

NPI: 1083476246
Provider Name (Legal Business Name): ELIZABETH CUEVAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11530 HIGHWAY 49 STE E
GULFPORT MS
39503-3089
US

IV. Provider business mailing address

21661 SANDSTONE LN
GULFPORT MS
39503-6307
US

V. Phone/Fax

Practice location:
  • Phone: 228-707-2007
  • Fax: 228-707-4119
Mailing address:
  • Phone: 228-563-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberM8405
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: