Provider Demographics
NPI:1710274030
Name:DELACRUZ, TRACY (MFT TRAINEE)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S L ST
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-2323
Mailing Address - Country:US
Mailing Address - Phone:559-591-6680
Mailing Address - Fax:559-591-6684
Practice Address - Street 1:144 S L ST
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-2323
Practice Address - Country:US
Practice Address - Phone:559-591-6680
Practice Address - Fax:559-591-6684
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health