Provider Demographics
NPI:1467585208
Name:SPECHT, ELLEN GIBB (PHD)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:GIBB
Last Name:SPECHT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 HILLSIDE CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-1304
Mailing Address - Country:US
Mailing Address - Phone:707-443-6460
Mailing Address - Fax:707-444-8355
Practice Address - Street 1:2830 G ST
Practice Address - Street 2:SUITE D
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4446
Practice Address - Country:US
Practice Address - Phone:707-444-8355
Practice Address - Fax:707-444-8355
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 30827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health