Provider Demographics
NPI:1679709166
Name:NIETO, ELIZABETH (MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NIETO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:NIETO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:401 W MORRISON AVE
Mailing Address - Street 2:SUITE A, OFFICE 1
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-6124
Mailing Address - Country:US
Mailing Address - Phone:805-347-3338
Mailing Address - Fax:
Practice Address - Street 1:401 W MORRISON AVE
Practice Address - Street 2:SUITE A, OFFICE 1
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-6124
Practice Address - Country:US
Practice Address - Phone:805-347-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53572106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist