Healthcare Provider Details

I. General information

NPI: 1063698363
Provider Name (Legal Business Name): TRACY MICHELLE SWAY HOFSTATTER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16055 VENTURA BLVD STE 500
ENCINO CA
91436-2601
US

IV. Provider business mailing address

15621 ODYSSEY DR #41
GRANADA HILLS CA
91344-3270
US

V. Phone/Fax

Practice location:
  • Phone: 818-925-5084
  • Fax:
Mailing address:
  • Phone: 818-925-5084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number84382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: