Healthcare Provider Details

I. General information

NPI: 1659413854
Provider Name (Legal Business Name): ELIZABETH MCKEY M.A., L.M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 CEDAR ST.
GARBERVILLE CA
95542
US

IV. Provider business mailing address

720 WOOD ST
EUREKA CA
95501-4413
US

V. Phone/Fax

Practice location:
  • Phone: 707-923-2729
  • Fax: 707-923-7207
Mailing address:
  • Phone: 707-923-2729
  • Fax: 707-923-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number43249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: