Provider Demographics
NPI:1487008629
Name:ELLIOTT, SIMONE (LMFT)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 KATELLA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2830
Mailing Address - Country:US
Mailing Address - Phone:714-451-6577
Mailing Address - Fax:
Practice Address - Street 1:5212 KATELLA AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2830
Practice Address - Country:US
Practice Address - Phone:714-451-6577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104537106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist