Provider Demographics
NPI:1467269191
Name:GERVAIS, ELIZABETH MARIE (LMFTA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:GERVAIS
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 COUNTY ROAD 1224
Mailing Address - Street 2:
Mailing Address - City:VINEMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35179-6595
Mailing Address - Country:US
Mailing Address - Phone:708-699-4480
Mailing Address - Fax:
Practice Address - Street 1:547 COUNTY ROAD 1224
Practice Address - Street 2:
Practice Address - City:VINEMONT
Practice Address - State:AL
Practice Address - Zip Code:35179-6595
Practice Address - Country:US
Practice Address - Phone:708-699-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALA131106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist