Basic Information
| Provider Information | |||||||||
| NPI: | 1225112501 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOO | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5784 LOLET WAY | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958352405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166076557 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9837 FOLSOM BLVD | ||||||||
| Address2: | STE F | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958271356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168565700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 08/11/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 49034 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.