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General NPI Number Information
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NPI Number | 1659625150
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Entity Type | Individual
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Provider Name | ELYSE EDLER SNIPES M.A.
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Gender | Female
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 300 S EL CAMINO REAL SUITE 105
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4069
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Country | US
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Telephone | 949-370-7103
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7241
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City | CAPO BEACH
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State | CA
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Zip | 92624-7241
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Country | US
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Telephone | 949-370-7103
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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 | 51619
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License Number State | CA
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