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General NPI Number Information
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NPI Number | 1114250594
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Entity Type | Individual
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Provider Name | ELIJAH NELLA LMFT
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Gender | Male
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 110 GOUGH ST STE 402
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-5971
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Country | US
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Telephone | 415-413-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 22 GARDEN ST SUITE 4
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City | RHINEBECK
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State | NY
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Zip | 12572-1300
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Country | US
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Telephone | 845-481-0036
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001313
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 85401
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License Number State | CA
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