Provider Demographics
NPI:1154752491
Name:TUFEKCIC, IVANA (MS)
Entity type:Individual
Prefix:
First Name:IVANA
Middle Name:
Last Name:TUFEKCIC
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 I ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4420
Mailing Address - Country:US
Mailing Address - Phone:916-606-7458
Mailing Address - Fax:
Practice Address - Street 1:3010 I ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4420
Practice Address - Country:US
Practice Address - Phone:916-606-7458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCI323101YP2500X
CAIMF76917106H00000X
CA105735106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional