Provider Demographics
NPI:1902563240
Name:LEFFLER, TRACY ELIZABETH (LMFT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ELIZABETH
Last Name:LEFFLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 17TH AVE # 1006
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1860
Mailing Address - Country:US
Mailing Address - Phone:559-492-0751
Mailing Address - Fax:
Practice Address - Street 1:2460 17TH AVE # 1006
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1860
Practice Address - Country:US
Practice Address - Phone:559-492-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT124628106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty