Provider Demographics
NPI:1356477020
Name:TREGUBOFF, WILLIAM JACK (MFT)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JACK
Last Name:TREGUBOFF
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 CUTTER PL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2716
Mailing Address - Country:US
Mailing Address - Phone:530-757-2430
Mailing Address - Fax:
Practice Address - Street 1:105 E ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4697
Practice Address - Country:US
Practice Address - Phone:530-757-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC14362106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist