Healthcare Provider Details

I. General information

NPI: 1164952727
Provider Name (Legal Business Name): ELIZABETH BAILEY RN, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19634 VENTURA BLVD
TARZANA CA
91356-2966
US

IV. Provider business mailing address

18226 VENTURA BLVD STE 202
TARZANA CA
91356-4246
US

V. Phone/Fax

Practice location:
  • Phone: 818-758-9450
  • Fax: 818-758-9450
Mailing address:
  • Phone: 310-344-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number117920
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: