Provider Demographics
NPI:1962886663
Name:CLIFTON, STEFANIE YURCICH (MFT)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:YURCICH
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:LYNN
Other - Last Name:YURCICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:732 3RD STREET, SUITE A
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-7310
Mailing Address - Country:US
Mailing Address - Phone:530-220-2784
Mailing Address - Fax:530-302-3382
Practice Address - Street 1:1003 COURT ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3520
Practice Address - Country:US
Practice Address - Phone:530-220-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48463106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist