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General NPI Number Information
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NPI Number | 1659763886
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Entity Type | Individual
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Provider Name | ELAINA LEASE
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Gender | Female
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 1119 PACIFIC AVE STE 200
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City | SANTA CRUZ
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State | CA
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Zip | 95060-4464
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Country | US
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Telephone | 831-426-5550
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Fax | 831-425-0106
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Provider Business Mailing Address
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Address Line | 1691 THE ALAMEDA
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City | SAN JOSE
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State | CA
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Zip | 95126-2203
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Country | US
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Telephone | 408-795-3619
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Fax | 408-287-0405
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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 | 83903
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License Number State | CA
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