Basic Information
| Provider Information | |||||||||
| NPI: | 1396216487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOBO | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18707 PARK HARBOR DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770843897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818144723 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9401 SOUTHWEST FWY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770741407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139707000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2018 | ||||||||
| LastUpdateDate: | 12/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 71416 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.