Provider Demographics
NPI:1295279099
Name:FAMILY COUNSELING OF ELK GROVE
Entity type:Organization
Organization Name:FAMILY COUNSELING OF ELK GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAPHNE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-512-5447
Mailing Address - Street 1:8920 EMERALD PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2380
Mailing Address - Country:US
Mailing Address - Phone:916-512-5447
Mailing Address - Fax:916-721-2447
Practice Address - Street 1:8920 EMERALD PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2380
Practice Address - Country:US
Practice Address - Phone:916-512-5447
Practice Address - Fax:916-721-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27778101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0001225635OtherMHN
CA816846OtherBEACON HEALTH
CA600800791OtherMAGELLAN
CA006-0204718OtherUNITED HEALTH CARE
CA100159241001OtherBLUE SHIELD OF CALIFORNIA
CA006-0204718OtherUNITED HEALTH CARE