Provider Demographics
NPI:1174989826
Name:GARCIA DE LEON, ELSA (MFT)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:GARCIA DE LEON
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 1:463 N 5TH ST
Mailing Address - Street 2:APT. 7
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5287
Mailing Address - Country:US
Mailing Address - Phone:405-516-6443
Mailing Address - Fax:
Practice Address - Street 1:16275 MONTEREY RD STE C
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5466
Practice Address - Country:US
Practice Address - Phone:408-778-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF90480106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist