Healthcare Provider Details

I. General information

NPI: 1770114308
Provider Name (Legal Business Name): ELIZABETH S HEUSER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2020
Last Update Date: 02/02/2020
Certification Date: 02/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MONTGOMERY ST STE 400
SAN FRANCISCO CA
94104-3410
US

IV. Provider business mailing address

24 CERRITOS AVE
SAN FRANCISCO CA
94127-2704
US

V. Phone/Fax

Practice location:
  • Phone: 415-787-3223
  • Fax:
Mailing address:
  • Phone: 415-308-3532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number104649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: