Provider Demographics
NPI:1780213827
Name:ELDER, JENNIFER T (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:ELDER
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 1:186 LITTLE JOHN CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4832
Mailing Address - Country:US
Mailing Address - Phone:818-304-4601
Mailing Address - Fax:
Practice Address - Street 1:2815 TOWNSGATE RD STE 115
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5826
Practice Address - Country:US
Practice Address - Phone:818-304-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30545106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist