Provider Demographics
NPI:1326413543
Name:PETTIT, ELIZABETH (MFTI)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PETTIT
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1324
Mailing Address - Country:US
Mailing Address - Phone:415-346-6384
Mailing Address - Fax:415-346-1058
Practice Address - Street 1:2441 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1324
Practice Address - Country:US
Practice Address - Phone:415-346-6384
Practice Address - Fax:415-346-1058
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88376106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist