Provider Demographics
NPI:1023208311
Name:ELLIOTT, MARIA DENISE (LMFT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DENISE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30263 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-8856
Mailing Address - Country:US
Mailing Address - Phone:559-658-8249
Mailing Address - Fax:559-658-8249
Practice Address - Street 1:30263 HORSESHOE DR
Practice Address - Street 2:
Practice Address - City:COARSEGOLD
Practice Address - State:CA
Practice Address - Zip Code:93614-8856
Practice Address - Country:US
Practice Address - Phone:559-658-8249
Practice Address - Fax:559-658-8249
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43048106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist