Healthcare Provider Details

I. General information

NPI: 1013868439
Provider Name (Legal Business Name): ELIZABETH CHANTEL VALDIVIA AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 BUHNE ST
EUREKA CA
95501-3238
US

IV. Provider business mailing address

PO BOX 8625
MORENO VALLEY CA
92552-8625
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-4593
  • Fax:
Mailing address:
  • Phone: 951-459-5436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: