MEDICARE: DR. ELIZABETH COLLISON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TH0004X	Health Psychologist

General Provider Information

NPI Number	:	1740739481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH COLLISON PH.D.

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD STE 1218
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4003
Country	:	US
Telephone Number	:	213-806-4918
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD STE 1218
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4003
Country	:	US
Telephone Number	:	213-712-9595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	06/29/2021

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