MEDICARE: ELAINA D WHITTENHALL ATR-BC, LPC-AT, LCPC

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	221700000X	Art Therapist	17-423
2	101YP2500X	Professional Counselor	79511	TX

General Provider Information

NPI Number	:	1942790746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINA D WHITTENHALL ATR-BC, LPC-AT, LCPC

Provider Business Mailing Address
First Line	:	3939 BEE CAVES RD STE A204
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6429
Country	:	US
Telephone Number	:	512-675-1873
Fax Number	:	512-287-5531

Provider Business Practice Location Address
First Line	:	3939 BEE CAVES RD STE A204
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6429
Country	:	US
Telephone Number	:	512-675-1873
Fax Number	:	512-287-5531

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

Provider Enumeration Date	:	05/16/2018
Last Update Date	:	08/14/2023

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