Basic Information
| Provider Information | |||||||||
| NPI: | 1164952727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | RN, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18226 VENTURA BLVD STE 202 | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913564246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103443382 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19634 VENTURA BLVD | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913562966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187589450 | ||||||||
| FaxNumber: | 8187589450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2017 | ||||||||
| LastUpdateDate: | 04/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | 117920 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.