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General NPI Number Information
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NPI Number | 1083385959
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Entity Type | Individual
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Provider Name | ELYSA CHRISTY SCHOOL PSYCHOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 105/713 ELIZABETH ST.
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City | WATERLOO
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State | NEW SOUTH WALES
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Zip | 2017X
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Country | AU
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Telephone | 614-567-6066
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Fax |
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Provider Business Mailing Address
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Address Line | 105/713 ELIZABETH ST.
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City | WATERLOO
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State | NEW SOUTH WALES
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Zip | 2017X
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Country | AU
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 160242679
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License Number State | CA
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