Provider Demographics
NPI:1346370707
Name:ELM, NIDIA ZOBEIDA (LMFT)
Entity Type:Individual
Prefix:
First Name:NIDIA
Middle Name:ZOBEIDA
Last Name:ELM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:NIDIA
Other - Middle Name:ZOBEIDA
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11225 N 28TH DR STE D111
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5630
Mailing Address - Country:US
Mailing Address - Phone:602-599-2000
Mailing Address - Fax:602-599-2009
Practice Address - Street 1:11225 N 28TH DR STE D111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5630
Practice Address - Country:US
Practice Address - Phone:602-599-2000
Practice Address - Fax:602-599-2009
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15293106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist