Provider Demographics
NPI:1619117132
Name:KROHN, ELIZABETH A (MFT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:KROHN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:KROHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:820 GRAVENSTEIN HIGHWAY SOUTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472
Mailing Address - Country:US
Mailing Address - Phone:707-823-3945
Mailing Address - Fax:
Practice Address - Street 1:820 GRAVENSTEIN HIGHWAY SOUTH
Practice Address - Street 2:SUITE 200
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472
Practice Address - Country:US
Practice Address - Phone:707-823-3945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC#23600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health