Healthcare Provider Details

I. General information

NPI: 1467395152
Provider Name (Legal Business Name): ELLIANA WOLNISTY LMFT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5758 GEARY BLVD # 322
SAN FRANCISCO CA
94121-2112
US

IV. Provider business mailing address

5758 GEARY BLVD # 322
SAN FRANCISCO CA
94121-2112
US

V. Phone/Fax

Practice location:
  • Phone: 510-575-9355
  • Fax:
Mailing address:
  • Phone: 510-575-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: