Provider Demographics
NPI:1972005346
Name:TELEKE, TRACY-KATE NICOLE PLUTSKY (LMFT)
Entity Type:Individual
Prefix:
First Name:TRACY-KATE
Middle Name:NICOLE PLUTSKY
Last Name:TELEKE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 OHIO WAY
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2124
Mailing Address - Country:US
Mailing Address - Phone:949-391-6381
Mailing Address - Fax:
Practice Address - Street 1:1129 OHIO WAY
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2124
Practice Address - Country:US
Practice Address - Phone:949-391-6381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93438106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist