Healthcare Provider Details

I. General information

NPI: 1255021093
Provider Name (Legal Business Name): BRENDA F ELIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MARKET ST
RIVERSIDE CA
92501-1720
US

IV. Provider business mailing address

1950 MARKET ST
RIVERSIDE CA
92501-1720
US

V. Phone/Fax

Practice location:
  • Phone: 951-530-5900
  • Fax:
Mailing address:
  • Phone: 951-530-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPCC13723
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC13723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: