Provider Demographics
NPI:1194151258
Name:BURLESON-PORRAS, ELISABETH J (LCSW)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:J
Last Name:BURLESON-PORRAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:
Other - Last Name:JUDICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:7004 BEE CAVES RD
Mailing Address - Street 2:BLDG. 2, SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5004
Mailing Address - Country:US
Mailing Address - Phone:512-306-1394
Mailing Address - Fax:512-306-1603
Practice Address - Street 1:7004 BEE CAVES RD
Practice Address - Street 2:BLDG. 2, SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5004
Practice Address - Country:US
Practice Address - Phone:512-306-1394
Practice Address - Fax:512-306-1603
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54671104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker