Provider Demographics
NPI:1093368730
Name:RICE, ELISE NICOLE (LMFT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:NICOLE
Last Name:RICE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:RELF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:500 CITY PKWY W STE 400
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2941
Mailing Address - Country:US
Mailing Address - Phone:714-834-7742
Mailing Address - Fax:
Practice Address - Street 1:500 CITY PKWY W STE 400
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2941
Practice Address - Country:US
Practice Address - Phone:714-834-7742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT91847101YM0800X
CA117311106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health