Provider Demographics
NPI:1295036010
Name:BRAVO, ELSA YOMAIRA (MS, MFT INTERN)
Entity Type:Individual
Prefix:MISS
First Name:ELSA
Middle Name:YOMAIRA
Last Name:BRAVO
Suffix:
Gender:F
Credentials:MS, MFT INTERN
Other - Prefix:MISS
Other - First Name:ELSA
Other - Middle Name:YOMAIRA
Other - Last Name:BRAVO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, MFT INTERN
Mailing Address - Street 1:1055 W HENDERSON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-1490
Mailing Address - Country:US
Mailing Address - Phone:559-556-1076
Mailing Address - Fax:559-713-3717
Practice Address - Street 1:1055 W HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1490
Practice Address - Country:US
Practice Address - Phone:559-788-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA75099106H00000X
CA118642106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor