Healthcare Provider Details

I. General information

NPI: 1154211241
Provider Name (Legal Business Name): STEFANY MARIE LEYVA APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ESTEFANIA MARIE LEYVA

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 GLASSON WAY
GRASS VALLEY CA
95945-5723
US

IV. Provider business mailing address

499 LOMA ALTA AVE
LOS GATOS CA
95030-6227
US

V. Phone/Fax

Practice location:
  • Phone: 916-520-4914
  • Fax:
Mailing address:
  • Phone: 408-379-3790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC24119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: