Healthcare Provider Details

I. General information

NPI: 1407448731
Provider Name (Legal Business Name): ELYSIAN COUNSELING & EDUCATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20214 TIMBERSTONE LN
SPRING TX
77379-8897
US

IV. Provider business mailing address

20214 TIMBERSTONE LN
SPRING TX
77379-8897
US

V. Phone/Fax

Practice location:
  • Phone: 832-928-5173
  • Fax: 832-203-1727
Mailing address:
  • Phone: 832-928-5173
  • Fax: 832-203-1727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. DWAN MICHELE MILAM-REED
Title or Position: OWNER & PRINCIPAL THERAPIST
Credential: PHD., LCSW-S
Phone: 832-928-5173