Provider Demographics
NPI:1750523858
Name:BIGHAM, ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:BIGHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 AVENIDA ENCINAS
Mailing Address - Street 2:SUITE 104, PMB 292
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4652
Mailing Address - Country:US
Mailing Address - Phone:619-517-3908
Mailing Address - Fax:
Practice Address - Street 1:701 PALOMAR AIRPORT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1027
Practice Address - Country:US
Practice Address - Phone:619-517-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical