MEDICARE: ELIZABETH HOULE LMFT

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	106H00000X	Marriage & Family Therapist	1234	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000000000	OTHER		NONE TO REPORT

General Provider Information

NPI Number	:	1336656289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HOULE LMFT

Provider Business Mailing Address
First Line	:	3944 GEORGETOWN RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-1805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 PEERLESS RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3431
Country	:	US
Telephone Number	:	423-650-7543
Fax Number	:

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

Provider Enumeration Date	:	01/01/2018
Last Update Date	:	01/01/2018

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Directions to “ ELIZABETH HOULE LMFT” Practice Location

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