Provider Demographics
NPI:1639731383
Name:MCLEAN, TRACEY
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:VOELTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 S SAN JACINTO AVE SPC 146
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-8546
Mailing Address - Country:US
Mailing Address - Phone:760-645-5511
Mailing Address - Fax:
Practice Address - Street 1:40925 COUNTY CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6037
Practice Address - Country:US
Practice Address - Phone:951-600-6360
Practice Address - Fax:951-600-6444
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)