=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275988149
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELAINE H. CAVAZOS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2016
-----------------------------------------------------
Last Update Date | 07/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2525 WALLINGWOOD DR STE 7D
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78746-6900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-537-4882
-----------------------------------------------------
Fax | 512-328-4108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2525 WALLINGWOOD DR STE 7D
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78746-6900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-537-4882
-----------------------------------------------------
Fax | 512-328-4108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCSW
-----------------------------------------------------
Name | ELAINE H CAVAZOS
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 512-537-4882
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 20632
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------