Provider Demographics
NPI:1114250594
Name:NELLA, ELIJAH (LMFT)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:
Last Name:NELLA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GARDEN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1300
Mailing Address - Country:US
Mailing Address - Phone:845-481-0036
Mailing Address - Fax:
Practice Address - Street 1:110 GOUGH ST STE 402
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5971
Practice Address - Country:US
Practice Address - Phone:415-413-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001313106H00000X
CA85401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist