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General NPI Number Information
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NPI Number | 1841907003
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Entity Type | Individual
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Provider Name | ELIZABETH BRACKENBURY
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Gender | Female
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 572 E GREEN ST STE 206
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City | PASADENA
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State | CA
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Zip | 91101-2075
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Country | US
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Telephone | 626-765-7506
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2501
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City | TOLUCA LAKE
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State | CA
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Zip | 91610-0501
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Country | US
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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