Elisabeth Christine Supan, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

100638 Issued in CA

Practice address

6101 Ball Rd
Cypress, CA 90630-3963

Phone

(562) 431-8822

NPI assigned

Aug 17, 2017

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Libby Christine Supan Other name

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": "1502928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1881110260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2514 E 6TH ST APT C",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908147365",
            "telephone_number": "661-747-0810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 BALL RD",
            "city": "CYPRESS",
            "state": "CA",
            "postal_code": "906303963",
            "telephone_number": "562-431-8822"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17326 Edwards Rd Ste 115",
            "address_purpose": "LOCATION",
            "city": "Cerritos",
            "state": "CA",
            "postal_code": "907032444",
            "country_code": "US",
            "telephone_number": "877-538-4133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUPAN",
        "first_name": "ELISABETH",
        "middle_name": "CHRISTINE",
        "name_prefix": "Ms.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-17",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "100638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALL OTHER INSURANCE CARRIERS",
            "identifier": "100638",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LIBBY",
            "last_name": "SUPAN",
            "middle_name": "CHRISTINE",
            "prefix": "MS.",
            "credential": "LMFT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Marriage & Family Therapist in Cypress, CA
• Providers in Cypress, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.