Provider Demographics
NPI:1104861202
Name:PREECE, TRACY LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LYNN
Last Name:PREECE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 JEFFERSON ST STE 10
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1708
Mailing Address - Country:US
Mailing Address - Phone:760-213-7204
Mailing Address - Fax:760-434-9778
Practice Address - Street 1:2725 JEFFERSON ST STE 10
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1708
Practice Address - Country:US
Practice Address - Phone:760-213-7204
Practice Address - Fax:760-434-9778
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16177103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB266508Medicare UPIN