MEDICARE: ELIZABETH HALLE 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	55621	TX

General Provider Information

NPI Number	:	1124578463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HALLE LCSW

Provider Business Mailing Address
First Line	:	7105 OLD KATY RD APT 4112
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2174
Country	:	US
Telephone Number	:	832-630-4009
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 BISSONNET ST STE 318
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-3996
Country	:	US
Telephone Number	:	832-630-4009
Fax Number	:

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

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	10/11/2016

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