Healthcare Provider Details

I. General information

NPI: 1811219405
Provider Name (Legal Business Name): ELIZABETH JANE STORM MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 DENBESTE CT 107
WINDSOR CA
95492
US

IV. Provider business mailing address

PO BOX 2119
SEBASTOPOL CA
95473-2119
US

V. Phone/Fax

Practice location:
  • Phone: 707-861-8167
  • Fax:
Mailing address:
  • Phone: 707-565-7819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC51181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: