Healthcare Provider Details

I. General information

NPI: 1629304688
Provider Name (Legal Business Name): ELITH HOLLAND LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 E HEBRON PKWY
CARROLLTON TX
75010-4427
US

IV. Provider business mailing address

384 FAIRLANDING AVE
FAIRVIEW TX
75069-6817
US

V. Phone/Fax

Practice location:
  • Phone: 972-428-7000
  • Fax: 972-428-2217
Mailing address:
  • Phone: 214-491-6199
  • Fax: 214-491-6199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number50578
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: