Elizabeth Kelishadi

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

ACSW90477 Issued in CA

Practice address

204 Hampton Dr
Venice, CA 90291-8633

Phone

(310) 396-6468

Fax

(310) 392-8402

NPI assigned

Aug 9, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576108800000",
    "number": "1124543236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3045 SCHOLARSHIP",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926124420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 HAMPTON DR",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902918633",
            "telephone_number": "310-396-6468",
            "fax_number": "310-392-8402"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18350 Mount Langley St Ste 220",
            "address_purpose": "LOCATION",
            "city": "Fountain Valley",
            "state": "CA",
            "postal_code": "927086912",
            "country_code": "US",
            "telephone_number": "714-450-4128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELISHADI",
        "first_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-09",
        "last_updated": "2019-12-12",
        "certification_date": "2019-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ACSW90477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Traci Kapp
• Allee Karmazyn
• Beverly Ann Karpman, M.D.
• Tanya Kavoussi
• Despina Ghaby Kayichian, M.D.
• Sandra Diane Kellar, RADT
• Bridget Kelleher, NP
• Briana Kelly
• Lacy Stuart Kelly, MS
• Shannon Kelly

• Mental Health Counselor in Venice, CA
• Providers in Venice, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.