Provider Demographics
NPI:1649898164
Name:CANFIELD, ELIZABETH (MA, LPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:KELSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1108 GAS LIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-3458
Mailing Address - Country:US
Mailing Address - Phone:920-210-9778
Mailing Address - Fax:
Practice Address - Street 1:1108 GAS LIGHT DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-3458
Practice Address - Country:US
Practice Address - Phone:920-210-9778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7879OtherWISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
WI7879OtherWISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES