Provider Demographics
NPI:1033361019
Name:LABASTIDA, ELENA A (MFT INTERN)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:A
Last Name:LABASTIDA
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S FARRELL DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7905
Mailing Address - Country:US
Mailing Address - Phone:760-416-1360
Mailing Address - Fax:760-416-8407
Practice Address - Street 1:333 S FARRELL DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7905
Practice Address - Country:US
Practice Address - Phone:760-416-1360
Practice Address - Fax:760-416-8407
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist