Provider Demographics
NPI:1730205733
Name:KORMEILI, ELIKA (MFT)
Entity type:Individual
Prefix:
First Name:ELIKA
Middle Name:
Last Name:KORMEILI
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:PO BOX 17144
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-7144
Mailing Address - Country:US
Mailing Address - Phone:424-274-2256
Mailing Address - Fax:
Practice Address - Street 1:11755 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1250
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1506
Practice Address - Country:US
Practice Address - Phone:424-274-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF47953106H00000X
CA45623106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist