Provider Demographics
NPI:1730308032
Name:HELLER, TRACY LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LEE
Last Name:HELLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 TROPICAL AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1619
Mailing Address - Country:US
Mailing Address - Phone:626-351-0888
Mailing Address - Fax:626-351-0888
Practice Address - Street 1:130 S EUCLID AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2446
Practice Address - Country:US
Practice Address - Phone:626-351-0888
Practice Address - Fax:626-351-0888
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14758103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist