Provider Demographics
NPI:1366154890
Name:TERRAZAS-CARRILLO, ELIZABETH C (PHD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:TERRAZAS-CARRILLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 PORT EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8934
Mailing Address - Country:US
Mailing Address - Phone:956-202-0042
Mailing Address - Fax:
Practice Address - Street 1:1906 PORT EDWARD DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-8934
Practice Address - Country:US
Practice Address - Phone:956-202-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37353103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling