Healthcare Provider Details

I. General information

NPI: 1225329253
Provider Name (Legal Business Name): ELIZABETH ESALEN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MISSION ST
SANTA CRUZ CA
95060-3614
US

IV. Provider business mailing address

208 WOODROW AVE
SANTA CRUZ CA
95060-6416
US

V. Phone/Fax

Practice location:
  • Phone: 831-600-7103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY24204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: