Provider Demographics
NPI:1952074254
Name:SHMIKLER, ELIZABETH (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SHMIKLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 S LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8520
Mailing Address - Country:US
Mailing Address - Phone:805-366-4032
Mailing Address - Fax:
Practice Address - Street 1:7516 ENTERPRISE AVE # 1
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3802
Practice Address - Country:US
Practice Address - Phone:901-755-5802
Practice Address - Fax:901-757-2249
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3965103T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist