Provider Demographics
NPI:1659514313
Name:BOLSINGER, ELIZABETH A (MA, MFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:BOLSINGER
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:BOLSINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:27126 PASEO ESPADA
Mailing Address - Street 2:SUITE 722
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CALIFORNIA
Mailing Address - Zip Code:92675
Mailing Address - Country:UM
Mailing Address - Phone:949-697-8251
Mailing Address - Fax:
Practice Address - Street 1:27126 PASEO ESPADA
Practice Address - Street 2:SUITE 722
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2721
Practice Address - Country:US
Practice Address - Phone:949-697-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist