Provider Demographics
NPI:1518088137
Name:ASTACIO-CEBALLOS, ELSA A (LMFT)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:A
Last Name:ASTACIO-CEBALLOS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:A
Other - Last Name:ASTACIO-CEBALLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:1263 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2705
Mailing Address - Country:US
Mailing Address - Phone:415-502-3000
Mailing Address - Fax:415-597-8004
Practice Address - Street 1:1263 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2705
Practice Address - Country:US
Practice Address - Phone:415-502-3000
Practice Address - Fax:415-597-8004
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96605106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist