Provider Demographics
NPI:1083385959
Name:CHRISTY, ELYSA (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:ELYSA
Middle Name:
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105/713 ELIZABETH ST.
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NEW SOUTH WALES
Mailing Address - Zip Code:2017X
Mailing Address - Country:AU
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105/713 ELIZABETH ST.
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NEW SOUTH WALES
Practice Address - Zip Code:2017X
Practice Address - Country:AU
Practice Address - Phone:614-567-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160242679103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool