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General NPI Number Information
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NPI Number | 1336864792
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Entity Type | Individual
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Provider Name | ELIZABETH MUTO LPC, LCDC
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Gender | Female
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Dates
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Enumeration Date | 10/07/2022
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 2800 E SPRING CREEK PKWY # D135
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City | PLANO
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State | TX
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Zip | 75074-3300
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Country | US
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Telephone | 972-948-6840
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Fax |
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Provider Business Mailing Address
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Address Line | 1809 RAINBOW DR
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City | RICHARDSON
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State | TX
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Zip | 75081-4712
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12381
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 71731
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License Number State | TX
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