Provider Demographics
NPI:1962665356
Name:WOOLSEY, ELTON DAVID (LPC)
Entity Type:Individual
Prefix:MR
First Name:ELTON
Middle Name:DAVID
Last Name:WOOLSEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 KREBS LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7075
Mailing Address - Country:US
Mailing Address - Phone:512-443-1583
Mailing Address - Fax:
Practice Address - Street 1:3625 MANCHACA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6631
Practice Address - Country:US
Practice Address - Phone:512-517-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health