MEDICARE: MR. THOMAS STEFFORA L.M.F.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	88567	CA

General Provider Information

NPI Number	:	1154588523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS STEFFORA L.M.F.T.

Provider Business Mailing Address
First Line	:	640 MISTY GLEN PL
Second Line	:
City	:	NIPOMO
State	:	CA
Zip	:	93444-5746
Country	:	US
Telephone Number	:	805-929-6908
Fax Number	:	805-929-6909

Provider Business Practice Location Address
First Line	:	301 S MILLER ST
Second Line	:	SUITE 112
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-5205
Country	:	US
Telephone Number	:	805-310-1878
Fax Number	:	805-929-6909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	12/12/2016

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