Provider Demographics
NPI:1992213615
Name:LABOLT, ELIZABETH W (LMFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:W
Last Name:LABOLT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 OCEAN AVE APT 408
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-3619
Mailing Address - Country:US
Mailing Address - Phone:708-785-2692
Mailing Address - Fax:
Practice Address - Street 1:1755 OCEAN AVE APT 408
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-3619
Practice Address - Country:US
Practice Address - Phone:708-785-2692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALLMFT88920106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist