Provider Demographics
NPI:1568042398
Name:ELIZABETH B. MINTO LPC LLC
Entity Type:Organization
Organization Name:ELIZABETH B. MINTO LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:MINTO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:251-402-3982
Mailing Address - Street 1:1290 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-8624
Mailing Address - Country:US
Mailing Address - Phone:251-402-3982
Mailing Address - Fax:
Practice Address - Street 1:1290 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-8624
Practice Address - Country:US
Practice Address - Phone:251-402-3982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health