Provider Demographics
NPI:1245323740
Name:ELLIOTT, JOHN FOSTER (MA, MFT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FOSTER
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6442 COLDWATER CANYON
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606
Mailing Address - Country:US
Mailing Address - Phone:818-509-0600
Mailing Address - Fax:818-509-9536
Practice Address - Street 1:6442 COLDWATER CANYON
Practice Address - Street 2:SUITE 114
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606
Practice Address - Country:US
Practice Address - Phone:818-509-0600
Practice Address - Fax:818-509-9536
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC16253106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist