MEDICARE: ELLEN TREACY KLAVAN MA, MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	45010	CA

General Provider Information

NPI Number	:	1427385061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN TREACY KLAVAN MA, MFT

Provider Business Mailing Address
First Line	:	253 SANTA ROSA LN
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2613
Country	:	US
Telephone Number	:	805-969-6750
Fax Number	:	805-884-1529

Provider Business Practice Location Address
First Line	:	800 GARDEN ST
Second Line	:	SUITE I
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-1552
Country	:	US
Telephone Number	:	805-969-6750
Fax Number	:	805-884-1529

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	11/03/2009

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