Provider Demographics
NPI:1922303783
Name:VON TERSCH, ELISE
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:VON TERSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2907
Mailing Address - Country:US
Mailing Address - Phone:916-730-3820
Mailing Address - Fax:
Practice Address - Street 1:218 DELTA AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1603
Practice Address - Country:US
Practice Address - Phone:925-513-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110339106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist