Provider Demographics
NPI:1649707266
Name:KRESOJEVICH, ELIZABETH A (LMFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:KRESOJEVICH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9260 E RAINTREE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7310
Mailing Address - Country:US
Mailing Address - Phone:602-300-3208
Mailing Address - Fax:
Practice Address - Street 1:9260 E RAINTREE DR STE 120
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7310
Practice Address - Country:US
Practice Address - Phone:602-300-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAMFT-10657106H00000X
390200000X
AZLMFT-15785106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program