Provider Demographics
NPI:1154689693
Name:NYBERG, ELIZABETH R (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:R
Last Name:NYBERG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 BREVARD AVE
Mailing Address - Street 2:106
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7973
Mailing Address - Country:US
Mailing Address - Phone:321-632-5792
Mailing Address - Fax:321-632-5796
Practice Address - Street 1:505 BREVARD AVE
Practice Address - Street 2:106
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7973
Practice Address - Country:US
Practice Address - Phone:321-632-5792
Practice Address - Fax:321-632-5796
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health