Healthcare Provider Details

I. General information

NPI: 1669202149
Provider Name (Legal Business Name): ELIZABETH M. KIACZ MA, AMFT, APCC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 E HUNTINGTON DR
ARCADIA CA
91006-6203
US

IV. Provider business mailing address

1825 N VERMONT AVE UNIT 27131
LOS ANGELES CA
90027-6426
US

V. Phone/Fax

Practice location:
  • Phone: 513-763-0179
  • Fax:
Mailing address:
  • Phone: 513-763-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number146594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: