Provider Demographics
NPI:1972817484
Name:MITTEL, ELAINE CARLSON (LBSW)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:CARLSON
Last Name:MITTEL
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13005 HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7341
Mailing Address - Country:US
Mailing Address - Phone:512-458-7111
Mailing Address - Fax:512-458-7334
Practice Address - Street 1:13005 HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7341
Practice Address - Country:US
Practice Address - Phone:512-619-8471
Practice Address - Fax:512-458-7334
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13926251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management