Healthcare Provider Details

I. General information

NPI: 1780674713
Provider Name (Legal Business Name): ELIZABETH MARIE STILL MFT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 I ST
SACRAMENTO CA
95816-4421
US

IV. Provider business mailing address

3101 I ST
SACRAMENTO CA
95816-4421
US

V. Phone/Fax

Practice location:
  • Phone: 916-448-2198
  • Fax: 916-514-8259
Mailing address:
  • Phone: 916-448-2198
  • Fax: 916-514-8259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number38575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: