Healthcare Provider Details

I. General information

NPI: 1649863176
Provider Name (Legal Business Name): ELLIOTT JAMES HALEY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PINE AVE STE 514
LONG BEACH CA
90802-2309
US

IV. Provider business mailing address

320 PINE AVE STE 514
LONG BEACH CA
90802-2309
US

V. Phone/Fax

Practice location:
  • Phone: 661-400-2609
  • Fax:
Mailing address:
  • Phone: 661-400-2609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: