Provider Demographics
NPI:1184706210
Name:ELROD, RETA KATHLEEN (LPC)
Entity type:Individual
Prefix:MISS
First Name:RETA
Middle Name:KATHLEEN
Last Name:ELROD
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 1:2901 BARTON SKWY APT 3312
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7562
Mailing Address - Country:US
Mailing Address - Phone:512-779-7101
Mailing Address - Fax:512-494-0788
Practice Address - Street 1:1221 W BEN WHITE BLVD
Practice Address - Street 2:SUITE 108A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7192
Practice Address - Country:US
Practice Address - Phone:512-779-7101
Practice Address - Fax:512-494-0788
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62041101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor