MEDICARE: DR. TATIANA GLEBOVA PHD, LMFT

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	MFC 53527	CA

General Provider Information

NPI Number	:	1649685835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TATIANA GLEBOVA PHD, LMFT

Provider Business Mailing Address
First Line	:	2030 W EL CAMINO AVE
Second Line	:	SUITE 200
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-1866
Country	:	US
Telephone Number	:	916-561-3214
Fax Number	:	916-565-2959

Provider Business Practice Location Address
First Line	:	2030 W EL CAMINO AVE
Second Line	:	SUITE 200
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-1866
Country	:	US
Telephone Number	:	916-561-3214
Fax Number	:	916-565-2959

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

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	06/25/2014

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