Provider Demographics
NPI:1427738970
Name:KRMPOTICH, ELYSSA (APCC)
Entity type:Individual
Prefix:
First Name:ELYSSA
Middle Name:
Last Name:KRMPOTICH
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 TEMPLE AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-5204
Mailing Address - Country:US
Mailing Address - Phone:815-909-5944
Mailing Address - Fax:
Practice Address - Street 1:3950 LONG BEACH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-5410
Practice Address - Country:US
Practice Address - Phone:562-684-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13853101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional