Healthcare Provider Details

I. General information

NPI: 1700912466
Provider Name (Legal Business Name): ELISABETH C BOX LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/21/2022
Certification Date: 08/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 KIRBY WAY
NIPOMO CA
93444-9678
US

IV. Provider business mailing address

110 S MARY AVE STE 2 PMB 122
NIPOMO CA
93444-8750
US

V. Phone/Fax

Practice location:
  • Phone: 805-266-8001
  • Fax:
Mailing address:
  • Phone: 805-266-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119471
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier119471
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerBOARD OF BEHAVIORAL SCIENCES

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: