Provider Demographics
NPI:1629670500
Name:RICHARDS, ELISA
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 BAY AVE
Mailing Address - Street 2:PO BOX 1861
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010
Mailing Address - Country:US
Mailing Address - Phone:831-234-5036
Mailing Address - Fax:
Practice Address - Street 1:1503 GRANT RD STE 110
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3270
Practice Address - Country:US
Practice Address - Phone:650-484-1213
Practice Address - Fax:408-642-6052
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA141282106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor