Provider Demographics
NPI:1023514452
Name:POLLOCK, ELIZABETH DAVENPORT
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DAVENPORT
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7146
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77387-7146
Mailing Address - Country:US
Mailing Address - Phone:832-926-8118
Mailing Address - Fax:
Practice Address - Street 1:1610 WOODSTEAD CT STE 420
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3404
Practice Address - Country:US
Practice Address - Phone:832-926-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202068106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist