Basic Information
| Provider Information | |||||||||
| NPI: | 1841447760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PORTZEL | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CAADACA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 DON LORENZO CT | ||||||||
| Address2: | |||||||||
| City: | APTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950035816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316628099 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 516 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950603669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314239015 | ||||||||
| FaxNumber: | 8314239098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2008 | ||||||||
| LastUpdateDate: | 08/21/2008 | ||||||||
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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 | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.