Basic Information
| Provider Information | |||||||||
| NPI: | 1740598408 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12926 MERRY MEADOWS DR | ||||||||
| Address2: | |||||||||
| City: | EASTVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928808545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627064971 | ||||||||
| FaxNumber: | 7149539155 | ||||||||
| Practice Location | |||||||||
| Address1: | 6800 INDIANA AVE STE 260 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925064287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517820040 | ||||||||
| FaxNumber: | 9517822010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2010 | ||||||||
| LastUpdateDate: | 07/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF 63018 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | IMF91927 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.