Provider Demographics
NPI:1922328863
Name:MCCORVEY BRAY, TRACI ELAINE (MASTERS (MFTC))
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:ELAINE
Last Name:MCCORVEY BRAY
Suffix:
Gender:F
Credentials:MASTERS (MFTC)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4859 W SLAUSON AVE # 492
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1290
Mailing Address - Country:US
Mailing Address - Phone:323-293-9932
Mailing Address - Fax:
Practice Address - Street 1:5150 E PCH STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3394
Practice Address - Country:US
Practice Address - Phone:562-498-5526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT94849106H00000X
CAIMF89349106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist