Provider Demographics
NPI:1659715100
Name:POWER, ELAINE SHAVER (LMFT)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:SHAVER
Last Name:POWER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:SHAVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1744 TIERRA NUEVA LN
Mailing Address - Street 2:
Mailing Address - City:OCEANO
Mailing Address - State:CA
Mailing Address - Zip Code:93445-9126
Mailing Address - Country:US
Mailing Address - Phone:805-703-8870
Mailing Address - Fax:
Practice Address - Street 1:1411 MARSH ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2968
Practice Address - Country:US
Practice Address - Phone:805-703-8870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99206106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist