Basic Information
| Provider Information | |||||||||
| NPI: | 1265808463 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARMSTRONG | ||||||||
| FirstName: | ELYSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2218 MARICOPA WAY | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958332732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438198012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 UNIVERSITY AVE STE 175 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958256739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884283223 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2015 | ||||||||
| LastUpdateDate: | 02/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 91130 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106S00000X | Y |
No ID Information.