Provider Demographics
NPI:1750418190
Name:CRIST, ELISSA (LMFT)
Entity type:Individual
Prefix:MISS
First Name:ELISSA
Middle Name:
Last Name:CRIST
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 1:1211 EUCLID AVE
Mailing Address - Street 2:APT. 11
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-4683
Mailing Address - Country:US
Mailing Address - Phone:954-292-1387
Mailing Address - Fax:
Practice Address - Street 1:2400 W CYPRESS CREEK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1824
Practice Address - Country:US
Practice Address - Phone:954-292-1387
Practice Address - Fax:954-771-5766
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2172106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist