Provider Demographics
NPI:1598287021
Name:TABORDON, TRACI
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:TABORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 E VALLEY RD #5164
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150
Mailing Address - Country:US
Mailing Address - Phone:804-881-3155
Mailing Address - Fax:
Practice Address - Street 1:1470 E VALLEY RD # 5164
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108
Practice Address - Country:US
Practice Address - Phone:805-881-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111320106H00000X
390200000X
CA127149106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program