Healthcare Provider Details

I. General information

NPI: 1578039202
Provider Name (Legal Business Name): ELISSA BETH HURAND LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2018
Last Update Date: 10/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 SANTA MONICA BLVD STE 200
SANTA MONICA CA
90401-3408
US

IV. Provider business mailing address

21046 WAVEVIEW DR
TOPANGA CA
90290-3553
US

V. Phone/Fax

Practice location:
  • Phone: 619-993-8465
  • Fax:
Mailing address:
  • Phone: 619-993-8465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: