Provider Demographics
NPI:1730547753
Name:WALLI, ELIZABETH CAROLINE (LMFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CAROLINE
Last Name:WALLI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:WALLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:13001 SEAL BEACH BLVD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2753
Mailing Address - Country:US
Mailing Address - Phone:714-584-4447
Mailing Address - Fax:
Practice Address - Street 1:13001 SEAL BEACH BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2753
Practice Address - Country:US
Practice Address - Phone:714-584-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85860106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist