Provider Demographics
NPI:1700806528
Name:SMALLWOOD, ELVA GAYTAN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ELVA
Middle Name:GAYTAN
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10620 QUEZADA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3405
Mailing Address - Country:US
Mailing Address - Phone:915-564-6159
Mailing Address - Fax:915-564-7861
Practice Address - Street 1:5001 N PIEDRAS ST
Practice Address - Street 2:116A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-4210
Practice Address - Country:US
Practice Address - Phone:915-564-6159
Practice Address - Fax:915-564-7861
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX083221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical