MEDICARE: TRACI TABORDON

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	111320	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	106H00000X	Marriage & Family Therapist	127149	CA

General Provider Information

NPI Number	:	1598287021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI TABORDON

Provider Business Mailing Address
First Line	:	1470 E VALLEY RD #5164
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93150
Country	:	US
Telephone Number	:	804-881-3155
Fax Number	:

Provider Business Practice Location Address
First Line	:	1470 E VALLEY RD # 5164
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108
Country	:	US
Telephone Number	:	805-881-3155
Fax Number	:

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

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	03/21/2022

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Directions to “ TRACI TABORDON ” Practice Location

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