Provider Demographics
NPI:1174859466
Name:CRENSHAW, ELIZABETH ANDREA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANDREA
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:ANDREA
Other - Last Name:WEILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:4836 KIERAN CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7400
Mailing Address - Country:US
Mailing Address - Phone:707-538-3736
Mailing Address - Fax:
Practice Address - Street 1:1212 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3908
Practice Address - Country:US
Practice Address - Phone:707-775-9895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist