Provider Demographics
NPI:1790806438
Name:DAVID, TRACEY ANNE (MFT)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:ANNE
Last Name:DAVID
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 1:13 FORREST AVE # B
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-4403
Mailing Address - Country:US
Mailing Address - Phone:408-395-8095
Mailing Address - Fax:
Practice Address - Street 1:20688 4TH ST STE 3
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5894
Practice Address - Country:US
Practice Address - Phone:408-327-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist