Provider Demographics
NPI:1902029812
Name:LICHT, ELIZABETH STREETT (LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:STREETT
Last Name:LICHT
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:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:HENNIKER
Mailing Address - State:NH
Mailing Address - Zip Code:03242-0529
Mailing Address - Country:US
Mailing Address - Phone:603-428-7400
Mailing Address - Fax:
Practice Address - Street 1:41 LIBERTY HILL RD
Practice Address - Street 2:BLDG 2 SUITE 218
Practice Address - City:HENNIKER
Practice Address - State:NH
Practice Address - Zip Code:03242-6045
Practice Address - Country:US
Practice Address - Phone:603-428-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH100106H00000X
NH760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH204965864Medicaid