Provider Demographics
NPI:1205967189
Name:MYERS, ELIZABETH (MFT, CT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MFT, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 MAIN STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1924
Mailing Address - Country:US
Mailing Address - Phone:650-619-9331
Mailing Address - Fax:650-728-8146
Practice Address - Street 1:725 MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1924
Practice Address - Country:US
Practice Address - Phone:650-619-9331
Practice Address - Fax:650-728-8146
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41082106H00000X
CALMFT41082106H00000X
CALPCC1386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional