MEDICARE: MRS. ELIZABETH S. PEASE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	39584	TX

General Provider Information

NPI Number	:	1023097235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH S. PEASE LCSW

Provider Business Mailing Address
First Line	:	14265 LOST MEADOW LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-3196
Country	:	US
Telephone Number	:	713-515-5294
Fax Number	:	917-591-5278

Provider Business Practice Location Address
First Line	:	3701 KIRBY DR
Second Line	:	SUITE 890
City	:	HOUSTON
State	:	TX
Zip	:	77098-3900
Country	:	US
Telephone Number	:	713-515-5294
Fax Number	:	917-591-5278

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	07/08/2007

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