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General NPI Number Information
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NPI Number | 1891409611
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Entity Type | Individual
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Provider Name | ELIZABETH FORMAN LPC
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Gender | Female
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 411 PARK GROVE DR STE 720
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City | KATY
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State | TX
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Zip | 77450-1577
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Country | US
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Telephone | 346-482-7730
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Fax |
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Provider Business Mailing Address
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Address Line | 3027 FRESCO WELLS DR
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City | KATY
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State | TX
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Zip | 77449-4617
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Country | US
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Telephone | 281-221-2076
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 83139
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License Number State | TX
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