Provider Demographics
NPI:1205983822
Name:SNEAD-CALLAWAY, ELIZABETH VAUGHAN
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:VAUGHAN
Last Name:SNEAD-CALLAWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LOU
Other - Middle Name:
Other - Last Name:SNEAD-CALLAWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1707 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-6041
Mailing Address - Country:US
Mailing Address - Phone:979-245-6976
Mailing Address - Fax:
Practice Address - Street 1:1707 5TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-6041
Practice Address - Country:US
Practice Address - Phone:979-245-6976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1884101YA0400X
TX224229163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult