Provider Demographics
NPI:1154406312
Name:FRAIN, ELIZABETH MARGARET (MFT)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARGARET
Last Name:FRAIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SLUMBER PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-5318
Mailing Address - Country:US
Mailing Address - Phone:707-446-9393
Mailing Address - Fax:707-455-6037
Practice Address - Street 1:724 TEXAS ST STE 205
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5519
Practice Address - Country:US
Practice Address - Phone:707-292-3559
Practice Address - Fax:707-528-2279
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT17057106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11585884OtherCAQH
CALMFT17057OtherLICENSE