Provider Demographics
NPI:1578659355
Name:ELISHA, PERRIN ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:PERRIN
Middle Name:ANNE
Last Name:ELISHA
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 1:1328 WESTWOOD BLVD
Mailing Address - Street 2:#7
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024
Mailing Address - Country:US
Mailing Address - Phone:310-857-6474
Mailing Address - Fax:303-484-5165
Practice Address - Street 1:1328 WESTWOOD BLVD
Practice Address - Street 2:#7
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:310-857-6474
Practice Address - Fax:303-484-5165
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM66972101YM0800X
CAPSY21535103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM88342OtherPROVIDER NUMBER PRESBYTER