Provider Demographics
NPI:1699079913
Name:FREDRICKSON, ELIZABETH A (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:FREDRICKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:FREDRICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4131 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:SUITE N-3
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8661
Mailing Address - Country:US
Mailing Address - Phone:512-914-0006
Mailing Address - Fax:512-343-2304
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD
Practice Address - Street 2:SUITE N-3
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8661
Practice Address - Country:US
Practice Address - Phone:512-914-0006
Practice Address - Fax:512-343-2304
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36895101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health