Provider Demographics
NPI:1083085757
Name:TRACY-SMITH, VERONIKA (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:VERONIKA
Middle Name:
Last Name:TRACY-SMITH
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73250
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-0108
Mailing Address - Country:US
Mailing Address - Phone:714-308-5759
Mailing Address - Fax:
Practice Address - Street 1:16052 BEACH BLVD STE 228
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3850
Practice Address - Country:US
Practice Address - Phone:714-308-5759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28776106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist