Provider Demographics
NPI:1679826994
Name:HEALZER, ELISE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:HEALZER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 DOUGLAS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310
Mailing Address - Country:US
Mailing Address - Phone:515-235-4720
Mailing Address - Fax:515-279-0136
Practice Address - Street 1:1402 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1947
Practice Address - Country:US
Practice Address - Phone:319-234-1572
Practice Address - Fax:319-234-1576
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000382106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist