Provider Demographics
NPI:1518372192
Name:REID, TRACY MICHELE
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MICHELE
Last Name:REID
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 1:24772 CHRISANTA DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4813
Mailing Address - Country:US
Mailing Address - Phone:949-480-7089
Mailing Address - Fax:949-707-0442
Practice Address - Street 1:24772 CHRISANTA DR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4813
Practice Address - Country:US
Practice Address - Phone:949-480-7089
Practice Address - Fax:949-707-0442
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist