Provider Demographics
NPI:1265678395
Name:DEVINE, ELIZABETH ROCHELLE (MED, LPC-S)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROCHELLE
Last Name:DEVINE
Suffix:
Gender:F
Credentials:MED, LPC-S
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ROCHELLE
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:821 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2009
Mailing Address - Country:US
Mailing Address - Phone:512-765-2668
Mailing Address - Fax:
Practice Address - Street 1:821 W 11TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2009
Practice Address - Country:US
Practice Address - Phone:512-765-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional