Provider Demographics
NPI:1720069685
Name:ESBENSHADE, ALICE H (MFT)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:H
Last Name:ESBENSHADE
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 1:226 E CANON PERDIDO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2258
Mailing Address - Country:US
Mailing Address - Phone:805-966-1212
Mailing Address - Fax:832-550-5932
Practice Address - Street 1:226 E CANON PERDIDO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2234
Practice Address - Country:US
Practice Address - Phone:805-966-1212
Practice Address - Fax:832-550-5932
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2008-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25458106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist