Provider Demographics
NPI:1669202149
Name:KIACZ, ELIZABETH M (MA, AMFT, APCC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:KIACZ
Suffix:
Gender:X
Credentials:MA, AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 N VERMONT AVE UNIT 27131
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6426
Mailing Address - Country:US
Mailing Address - Phone:513-763-0179
Mailing Address - Fax:
Practice Address - Street 1:444 E HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-6203
Practice Address - Country:US
Practice Address - Phone:513-763-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146594101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health