Healthcare Provider Details

I. General information

NPI: 1477694073
Provider Name (Legal Business Name): ELIZABETH MARIE TROSPER MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 S GRAND AVE
GLENDORA CA
91740-5000
US

IV. Provider business mailing address

10735 WESCOTT AVE
SUNLAND CA
91040-2335
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-5980
  • Fax: 626-335-5989
Mailing address:
  • Phone: 818-446-0678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 40360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: