Provider Demographics
NPI:1023111093
Name:ELOWITCH, HEIDI MICHELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:MICHELLE
Last Name:ELOWITCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1238 ALESSANDRO DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3503
Mailing Address - Country:US
Mailing Address - Phone:805-732-9446
Mailing Address - Fax:805-494-0575
Practice Address - Street 1:200 S WELLS RD
Practice Address - Street 2:CLINICAS DEL CAMINO REAL INC
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1302
Practice Address - Country:US
Practice Address - Phone:805-732-9446
Practice Address - Fax:805-647-7163
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29816103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist