Provider Demographics
NPI:1003417098
Name:CAMARENA-WEST, LIZ (MSCP, LMFT)
Entity type:Individual
Prefix:MRS
First Name:LIZ
Middle Name:
Last Name:CAMARENA-WEST
Suffix:
Gender:
Credentials:MSCP, 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 483
Mailing Address - Street 2:
Mailing Address - City:EL GRANADA
Mailing Address - State:CA
Mailing Address - Zip Code:94018-0483
Mailing Address - Country:US
Mailing Address - Phone:650-762-6062
Mailing Address - Fax:
Practice Address - Street 1:9260 ALCOSTA BLVD STE A5
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4132
Practice Address - Country:US
Practice Address - Phone:650-762-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121384106H00000X
CA145301101YM0800X, 106H00000X
CA8429101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional