Healthcare Provider Details

I. General information

NPI: 1629194360
Provider Name (Legal Business Name): ALLYCIA DAWN SOUZA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E ALAMAR AVE
SANTA BARBARA CA
93105-3046
US

IV. Provider business mailing address

133 E ALAMAR AVE
SANTA BARBARA CA
93105-3046
US

V. Phone/Fax

Practice location:
  • Phone: 510-374-8560
  • Fax:
Mailing address:
  • Phone: 510-374-8560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48056
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFTI 52783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: