Provider Demographics
NPI:1700912466
Name:BOX, ELISABETH C (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:C
Last Name:BOX
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 1:110 S MARY AVE STE 2
Mailing Address - Street 2:PMB 122
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-8750
Mailing Address - Country:US
Mailing Address - Phone:805-266-8001
Mailing Address - Fax:
Practice Address - Street 1:1631 KIRBY WAY
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-9678
Practice Address - Country:US
Practice Address - Phone:805-266-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119471106H00000X
106H00000X, 101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA119471OtherBOARD OF BEHAVIORAL SCIENCES