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General NPI Number Information
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NPI Number | 1164110268
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Entity Type | Individual
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Provider Name | DANIELLE ELYSE ROXBOROUGH AMFT
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Gender | Female
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 909 ELECTRIC AVE STE 308
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City | SEAL BEACH
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State | CA
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Zip | 90740-8903
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Country | US
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Telephone | 714-797-5445
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Fax |
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Provider Business Mailing Address
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Address Line | 2703 VICTORIA DR
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3950
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Country | US
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Telephone | 818-481-6229
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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 | 112972
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License Number State | CA
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