Provider Demographics
NPI:1912597733
Name:ANDERSON, ELIZABETH REGINA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:REGINA
Last Name:ANDERSON
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 1:10615 GILFORD CREST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3075
Mailing Address - Country:US
Mailing Address - Phone:512-876-6145
Mailing Address - Fax:
Practice Address - Street 1:3500 W DAVIS ST STE 250
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1811
Practice Address - Country:US
Practice Address - Phone:832-401-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79038101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional