Provider Demographics
NPI:1932348554
Name:VALENCIA, TRACY MIKAELIAN (LMFT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MIKAELIAN
Last Name:VALENCIA
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 1:3524 PRESCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-2015
Mailing Address - Country:US
Mailing Address - Phone:559-824-0913
Mailing Address - Fax:
Practice Address - Street 1:4324 W HARVARD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-5183
Practice Address - Country:US
Practice Address - Phone:559-681-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC405661041C0700X
CALMFT40566106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical