Healthcare Provider Details

I. General information

NPI: 1144678111
Provider Name (Legal Business Name): ELIZABETH CONGO LMFT 91048
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 PAJARO ST
SALINAS CA
93901-3400
US

IV. Provider business mailing address

409 SAN BERNABE DR
MONTEREY CA
93940-6126
US

V. Phone/Fax

Practice location:
  • Phone: 831-800-7530
  • Fax:
Mailing address:
  • Phone: 831-915-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number91048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: