Provider Demographics
NPI:1518105154
Name:MCWILLIAMS, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MCWILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-9558
Mailing Address - Country:US
Mailing Address - Phone:559-410-2538
Mailing Address - Fax:559-934-1657
Practice Address - Street 1:4944 E CLINTON WAY
Practice Address - Street 2:101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1527
Practice Address - Country:US
Practice Address - Phone:559-935-4900
Practice Address - Fax:559-934-1657
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)