Basic Information
| Provider Information | |||||||||
| NPI: | 1306356829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANK | ||||||||
| FirstName: | ELIA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LPCC 10208 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1430 WILLOW PASS RD | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945207928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082617777 | ||||||||
| FaxNumber: | 4082592273 | ||||||||
| Practice Location | |||||||||
| Address1: | 1430 WILLOW PASS RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945207946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256465774 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2017 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | APCC4961 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | APCC4961 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YP2500X | LPCC10208 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.