Provider Demographics
NPI:1508015447
Name:SANTIAGO, ELIZABETH KATHLEEN (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KATHLEEN
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:K
Other - Last Name:THEIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1158 TIVOLI LN
Mailing Address - Street 2:UNIT 177
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0983
Mailing Address - Country:US
Mailing Address - Phone:805-991-7633
Mailing Address - Fax:
Practice Address - Street 1:1158 TIVOLI LN
Practice Address - Street 2:UNIT 177
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-0983
Practice Address - Country:US
Practice Address - Phone:805-991-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53776106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist