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General NPI Number Information
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NPI Number | 1609240167
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Entity Type | Organization
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Legal Business Name | ELAINE'S TRIO GROUP, LLC
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 512 BOWIE
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City | UNIVERSAL CITY
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State | TX
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Zip | 78148-4407
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Country | US
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Telephone | 210-446-8797
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Fax |
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Provider Business Mailing Address
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Address Line | 133 WILLOW VW
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City | CIBOLO
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State | TX
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Zip | 78108-2261
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Country | US
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Telephone | 210-446-8797
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TU'SHEILA E. STEWART
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Credential | LCDC
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Telephone | 210-446-8797
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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 |
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License Number State |
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