Provider Demographics
NPI:1093891210
Name:SARDELICH, ELIZABETH FIGUEROA (MA, LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:FIGUEROA
Last Name:SARDELICH
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E MULBERRY
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-4733
Mailing Address - Country:US
Mailing Address - Phone:979-848-0766
Mailing Address - Fax:979-848-2136
Practice Address - Street 1:305 E MULBERRY
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4733
Practice Address - Country:US
Practice Address - Phone:979-848-0766
Practice Address - Fax:979-848-2136
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10079101YP2500X
TX019194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026209901Medicaid