Provider Demographics
NPI:1346601663
Name:ANNAMRAJU, ELIZABETH COOLEY (LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:COOLEY
Last Name:ANNAMRAJU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARIA
Other - Last Name:COOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22752 WHITE FIR LN
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2541
Mailing Address - Country:US
Mailing Address - Phone:909-576-5970
Mailing Address - Fax:
Practice Address - Street 1:22752 WHITE FIR LN
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2541
Practice Address - Country:US
Practice Address - Phone:909-576-5970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32107106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist