Provider Demographics
NPI:1700157138
Name:OLDHAM, ELIZABETH KAYE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KAYE
Last Name:OLDHAM
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 1:610 MIDNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-7023
Mailing Address - Country:US
Mailing Address - Phone:210-260-4257
Mailing Address - Fax:
Practice Address - Street 1:11550 I 10 WEST SUITE 155
Practice Address - Street 2:SUITE 155
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1945
Practice Address - Country:US
Practice Address - Phone:210-210-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65405101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional