Provider Demographics
NPI:1700050259
Name:ADAMS, ELLEN (LMFT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 SOQUEL DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2855
Mailing Address - Country:US
Mailing Address - Phone:831-460-1160
Mailing Address - Fax:
Practice Address - Street 1:5905 SOQUEL DR
Practice Address - Street 2:SUITE 600
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2855
Practice Address - Country:US
Practice Address - Phone:831-460-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40881106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist