Provider Demographics
NPI:1558576611
Name:HUMMERT, ELIZABETH FLEMING (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FLEMING
Last Name:HUMMERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 HOMECRAFT LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3667
Mailing Address - Country:US
Mailing Address - Phone:817-223-9734
Mailing Address - Fax:
Practice Address - Street 1:1723 HEMPHILL ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1516
Practice Address - Country:US
Practice Address - Phone:817-927-4039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40267104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker