Provider Demographics
NPI:1255504551
Name:MIDDLETON, ELIZABETH GRACE (MA MFT 48766)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GRACE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:MA MFT 48766
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6335
Mailing Address - Country:US
Mailing Address - Phone:949-375-0577
Mailing Address - Fax:
Practice Address - Street 1:101 MAIN STREET
Practice Address - Street 2:SUITE F
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6335
Practice Address - Country:US
Practice Address - Phone:949-375-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48766106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist