MEDICARE: HEATHER ELDER LPC

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	101YM0800X	Mental Health Counselor	76107	TX
2	101YP2500X	Professional Counselor	76107	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	76107	OTHER	TX	DSHS

General Provider Information

NPI Number	:	1346472065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER ELDER LPC

Provider Business Mailing Address
First Line	:	240 E RENFRO ST STE 201
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-3940
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 E RENFRO ST STE 201
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-3940
Country	:	US
Telephone Number	:	817-913-1517
Fax Number	:

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

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	11/14/2019

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Directions to “ HEATHER ELDER LPC” Practice Location

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