Provider Demographics
NPI:1871781591
Name:HAINE, ELIZABETH NICKELSON REESE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:NICKELSON REESE
Last Name:HAINE
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:8635 SAN FERNANDO WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4030
Mailing Address - Country:US
Mailing Address - Phone:214-827-0813
Mailing Address - Fax:
Practice Address - Street 1:14133 MEMORIAL DR STE 7
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6800
Practice Address - Country:US
Practice Address - Phone:832-230-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX359451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170304301Medicaid