Provider Demographics
NPI:1851570113
Name:FITZGERALD DONAHUE, TRACEY BETH (MS LMFT)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:BETH
Last Name:FITZGERALD DONAHUE
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24351 MOULTON PKWY
Mailing Address - Street 2:#120
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-422-1707
Mailing Address - Fax:949-586-5695
Practice Address - Street 1:24351 MOULTON PKWY
Practice Address - Street 2:#120
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-422-1707
Practice Address - Fax:949-586-5695
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT37721106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist