Provider Demographics
NPI:1154471530
Name:TACQUARD, TRACY DIANE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:DIANE
Last Name:TACQUARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 PEBBLE BAY CT
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1238
Mailing Address - Country:US
Mailing Address - Phone:951-764-0537
Mailing Address - Fax:951-848-9416
Practice Address - Street 1:1504 PEBBLE BAY CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1238
Practice Address - Country:US
Practice Address - Phone:951-764-0537
Practice Address - Fax:951-848-9416
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38834106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1154471530OtherOUTPATIENT MENTAL HEALTH