Provider Demographics
NPI:1588822795
Name:TRUE, TRACY JOHNS (MFT)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:JOHNS
Last Name:TRUE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 MOORPARK AVE
Mailing Address - Street 2:STE.4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2521
Mailing Address - Country:US
Mailing Address - Phone:408-247-7999
Mailing Address - Fax:408-369-8760
Practice Address - Street 1:3033 MOORPARK AVE
Practice Address - Street 2:STE.4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2521
Practice Address - Country:US
Practice Address - Phone:408-247-7999
Practice Address - Fax:408-369-8760
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMR24172106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist