Provider Demographics
NPI:1679904585
Name:SEAGRAVES, TORY BETH (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:TORY
Middle Name:BETH
Last Name:SEAGRAVES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 WESTERLY PL STE 190
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2344
Mailing Address - Country:US
Mailing Address - Phone:714-497-0768
Mailing Address - Fax:
Practice Address - Street 1:3990 WESTERLY PL STE 190
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2344
Practice Address - Country:US
Practice Address - Phone:714-497-0768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86295106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist