Provider Demographics
NPI:1346664984
Name:WHITE, ELIZABETH THERESE (LMFT133427)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:THERESE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMFT133427
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28348 ROADSIDE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2596
Mailing Address - Country:US
Mailing Address - Phone:818-305-4415
Mailing Address - Fax:
Practice Address - Street 1:28348 ROADSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2596
Practice Address - Country:US
Practice Address - Phone:818-305-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT133427106H00000X
CAIMF79375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist