Provider Demographics
NPI:1174853832
Name:ELDRED, ALYSE A (LMFT)
Entity Type:Individual
Prefix:
First Name:ALYSE
Middle Name:A
Last Name:ELDRED
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 E PACIFIC COAST HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3399
Mailing Address - Country:US
Mailing Address - Phone:805-448-2983
Mailing Address - Fax:
Practice Address - Street 1:5150 E PACIFIC COAST HWY STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3399
Practice Address - Country:US
Practice Address - Phone:805-448-2983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2017-11-27
Deactivation Date:2017-10-25
Deactivation Code:
Reactivation Date:2017-11-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689762486OtherTELECARE/CARES CRISIS RESIDENTIAL