Provider Demographics
NPI:1538315866
Name:ABALLI, ELISE WRIGHT (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:WRIGHT
Last Name:ABALLI
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:PO BOX 562
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-0562
Mailing Address - Country:US
Mailing Address - Phone:760-751-5336
Mailing Address - Fax:760-749-6819
Practice Address - Street 1:333 S JUNIPER ST
Practice Address - Street 2:SUITE 116
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4924
Practice Address - Country:US
Practice Address - Phone:760-751-5336
Practice Address - Fax:760-749-6819
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist