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General NPI Number Information
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NPI Number | 1952799702
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Entity Type | Organization
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Legal Business Name | ELM RIDGE ENTERPRISES, LLC
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 2235 N PEA RIDGE RD
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City | TEMPLE
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State | TX
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Zip | 76502-4613
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Country | US
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Telephone | 254-780-9571
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Fax | 254-780-2195
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Provider Business Mailing Address
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Address Line | 2235 N PEA RIDGE RD
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City | TEMPLE
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State | TX
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Zip | 76502-4613
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Country | US
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Telephone | 254-780-9571
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Fax | 254-780-2195
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Authorized Official
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Title or Position | PRESIDENT
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Name | LINDA MALSBARY
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Credential | LCSW
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Telephone | 254-780-9571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 36294
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License Number State | TX
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