Healthcare Provider Details

I. General information

NPI: 1619643764
Provider Name (Legal Business Name): JOSIE TRAUB LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 MEMORY LN
BOULDER CREEK CA
95006-9137
US

IV. Provider business mailing address

554 MEMORY LN
BOULDER CREEK CA
95006-9137
US

V. Phone/Fax

Practice location:
  • Phone: 805-712-4175
  • Fax:
Mailing address:
  • Phone: 805-712-4175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number138029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: