Provider Demographics
NPI:1255488425
Name:TIBBETTS, VICTORIA L (MFT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:TIBBETTS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4487 STONERIDGE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8326
Mailing Address - Country:US
Mailing Address - Phone:925-271-2423
Mailing Address - Fax:925-484-3045
Practice Address - Street 1:4487 STONERIDGE DR STE 103
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8326
Practice Address - Country:US
Practice Address - Phone:252-712-4239
Practice Address - Fax:925-484-3045
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34498106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist