Provider Demographics
NPI:1376041400
Name:BRAGGINS, ELISA MARIE STARNES (LMFT)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:MARIE STARNES
Last Name:BRAGGINS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:MARIE
Other - Last Name:STARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16453 BEAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1752
Mailing Address - Country:US
Mailing Address - Phone:760-956-4400
Mailing Address - Fax:
Practice Address - Street 1:16453 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1752
Practice Address - Country:US
Practice Address - Phone:760-956-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100790106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist