Provider Demographics
NPI:1093250565
Name:MOHUN, ELIZABETH GRACE (MFT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:GRACE
Last Name:MOHUN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 LOS FELIZ BLVD
Mailing Address - Street 2:2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2261
Mailing Address - Country:US
Mailing Address - Phone:716-560-0015
Mailing Address - Fax:
Practice Address - Street 1:4221 LOS FELIZ BLVD
Practice Address - Street 2:2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-2261
Practice Address - Country:US
Practice Address - Phone:716-560-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93670106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist