Healthcare Provider Details

I. General information

NPI: 1205967189
Provider Name (Legal Business Name): ELIZABETH MYERS MFT, CT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 MAIN STREET SUITE 1
HALF MOON BAY CA
94019-1924
US

IV. Provider business mailing address

725 MAIN STREET SUITE 1
HALF MOON BAY CA
94019-1924
US

V. Phone/Fax

Practice location:
  • Phone: 650-619-9331
  • Fax: 650-728-8146
Mailing address:
  • Phone: 650-619-9331
  • Fax: 650-728-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC1386
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 41082
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT41082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: