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: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15465 OAK LN STE 100F
GULFPORT MS
39503-2663
US

IV. Provider business mailing address

15465 OAK LN STE 100F
GULFPORT MS
39503-2663
US

V. Phone/Fax

Practice location:
  • Phone: 228-206-1824
  • Fax: 228-288-0208
Mailing address:
  • Phone: 228-206-1824
  • Fax: 228-288-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM8405
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: