Provider Demographics
NPI:1407395163
Name:JAFFEE-STAFFORD, ELIZABETH ANN (LMFT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:JAFFEE-STAFFORD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:JAFFEE-STAFFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:212 N OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-2632
Mailing Address - Country:US
Mailing Address - Phone:541-779-5242
Mailing Address - Fax:541-779-2523
Practice Address - Street 1:212 N OAKDALE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2632
Practice Address - Country:US
Practice Address - Phone:541-779-5242
Practice Address - Fax:541-779-2523
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0805106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist