MEDICARE: XENA ELYSE WOOLEY MFT INTERN

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		TX

General Provider Information

NPI Number	:	1386596310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XENA ELYSE WOOLEY MFT INTERN

Provider Business Mailing Address
First Line	:	1 SIGNATURE POINT DR APT 1616
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-6517
Country	:	US
Telephone Number	:	281-840-9963
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 E MAIN ST
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3743
Country	:	US
Telephone Number	:	281-819-0308
Fax Number	:

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

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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