Provider Demographics
NPI:1154689693
Name:NYBERG, ELIZABETH RENE (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:RENE
Last Name:NYBERG
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6769 N WICKHAM RD STE B101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2048
Mailing Address - Country:US
Mailing Address - Phone:321-321-1490
Mailing Address - Fax:833-767-2919
Practice Address - Street 1:6769 N WICKHAM RD STE B101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2048
Practice Address - Country:US
Practice Address - Phone:321-321-1490
Practice Address - Fax:833-767-2919
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health