Provider Demographics
NPI:1427385061
Name:KLAVAN, ELLEN TREACY (MA, MFT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:TREACY
Last Name:KLAVAN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 SANTA ROSA LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2613
Mailing Address - Country:US
Mailing Address - Phone:805-969-6750
Mailing Address - Fax:805-884-1529
Practice Address - Street 1:800 GARDEN ST
Practice Address - Street 2:SUITE I
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1552
Practice Address - Country:US
Practice Address - Phone:805-969-6750
Practice Address - Fax:805-884-1529
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist