Provider Demographics
NPI:1013560069
Name:HATLESTAD, ELIZABETH ROMIG (LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROMIG
Last Name:HATLESTAD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 OAKPARK DR
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-6616
Mailing Address - Country:US
Mailing Address - Phone:512-925-2039
Mailing Address - Fax:
Practice Address - Street 1:605 OAKPARK DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-6616
Practice Address - Country:US
Practice Address - Phone:512-925-2039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional