Healthcare Provider Details

I. General information

NPI: 1881558724
Provider Name (Legal Business Name): ELIZABETH ANNE ESCANUELAS AMFT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W FERN DR
FULLERTON CA
92833-2331
US

IV. Provider business mailing address

1400 W FERN DR
FULLERTON CA
92833-2331
US

V. Phone/Fax

Practice location:
  • Phone: 714-447-7710
  • Fax: 714-447-7542
Mailing address:
  • Phone: 714-447-7710
  • Fax: 714-447-7542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number158525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: