Provider Demographics
NPI:1336919273
Name:ELIOT, ANITA MARIE (MA LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:MARIE
Last Name:ELIOT
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 REDWING DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-4118
Mailing Address - Country:US
Mailing Address - Phone:707-480-4558
Mailing Address - Fax:
Practice Address - Street 1:75 REDWING DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4118
Practice Address - Country:US
Practice Address - Phone:707-480-4558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMU7589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist