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General NPI Number Information
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NPI Number | 1538490115
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Entity Type | Individual
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Provider Name | JEFFREY LEE EBBAGE
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Gender | Male
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Dates
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Enumeration Date | 01/21/2010
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 709 MISSION ST
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City | SANTA CRUZ
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State | CA
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Zip | 95060-3614
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Country | US
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Telephone | 831-429-8350
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Fax |
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Provider Business Mailing Address
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Address Line | 709 MISSION ST
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City | SANTA CRUZ
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State | CA
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Zip | 95060-3614
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Country | US
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Telephone | 831-429-8350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 91247
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License Number State | CA
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