Provider Demographics
NPI:1083310148
Name:MOHLER, TRACI COLLEEN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:COLLEEN
Last Name:MOHLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:COLLEEN
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11921 STOVALL WAY
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-3485
Mailing Address - Country:US
Mailing Address - Phone:951-258-4357
Mailing Address - Fax:
Practice Address - Street 1:11921 STOVALL WAY
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-3485
Practice Address - Country:US
Practice Address - Phone:951-258-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137482106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist