Basic Information
| Provider Information | |||||||||
| NPI: | 1659672293 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELIOR | ||||||||
| FirstName: | LAKME | ||||||||
| MiddleName: | BATYA | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11631 VICTORY BLVD STE 203 | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916063572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189083855 | ||||||||
| FaxNumber: | 8187535265 | ||||||||
| Practice Location | |||||||||
| Address1: | 11631 VICTORY BLVD STE 203 | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189083855 | ||||||||
| FaxNumber: | 8187535265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2010 | ||||||||
| LastUpdateDate: | 07/31/2018 | ||||||||
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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 | 106H00000X | 70011 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 106H00000X | 105423 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 105423 | 01 | CA | CA BBS | OTHER |