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NPI Code Detail

MEDICARE: ELIZABETH BETTY DIVINE LPC, LCDC

MEDICARE: ELIZABETH BETTY DIVINE LPC, LCDC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLCDC8902TX
2101YM0800XMental Health CounselorLPC17841TX

General Provider Information

NPI Number : 1821167842
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH BETTY DIVINE LPC, LCDC
Provider Business Mailing Address
First Line : 5855 DOLIVER DR
Second Line :
City : HOUSTON
State : TX
Zip : 77057-2474
Country : US
Telephone Number : 713-857-7755
Fax Number : 713-627-7715
Provider Business Practice Location Address
First Line : 4803 SAN FELIPE ST
Second Line :
City : HOUSTON
State : TX
Zip : 77056-3907
Country : US
Telephone Number : 713-626-7990
Fax Number : 713-627-7715
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 09/11/2025

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