Provider Demographics
NPI:1235441502
Name:WOLF, ELZIE DWIGHT (MA)
Entity Type:Individual
Prefix:MR
First Name:ELZIE
Middle Name:DWIGHT
Last Name:WOLF
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 WILLOWBEND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-3825
Mailing Address - Country:US
Mailing Address - Phone:713-824-4775
Mailing Address - Fax:
Practice Address - Street 1:4325 WILLOWBEND BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-3825
Practice Address - Country:US
Practice Address - Phone:713-824-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11562101YP2500X
TX3771106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional