Provider Demographics
NPI:1821173402
Name:MILVO, ELIZABETH J (LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:MILVO
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 1:2731 NACOGDOCHES RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5830
Mailing Address - Country:US
Mailing Address - Phone:210-675-0066
Mailing Address - Fax:210-247-9611
Practice Address - Street 1:2731 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5830
Practice Address - Country:US
Practice Address - Phone:210-675-0066
Practice Address - Fax:210-247-9611
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028341801Medicaid