MEDICARE: ELISE NELIUS 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	106H00000X	Marriage & Family Therapist	81059	TX
2	101YP2500X	Professional Counselor	81059	TX
3	101Y00000X	Counselor	81059	TX
4	101YM0800X	Mental Health Counselor	81059	TX
5	101YP1600X	Pastoral Counselor	81059	TX

General Provider Information

NPI Number	:	1891455234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE NELIUS LPC

Provider Business Mailing Address
First Line	:	8506 BURNING HILLS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1126
Country	:	US
Telephone Number	:	940-597-4342
Fax Number	:

Provider Business Practice Location Address
First Line	:	8506 BURNING HILLS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1126
Country	:	US
Telephone Number	:	940-597-4342
Fax Number	:

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

Provider Enumeration Date	:	12/27/2021
Last Update Date	:	12/27/2021

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