MEDICARE: MS. TRACY JOHNS TRUE MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MR24172	CA

General Provider Information

NPI Number	:	1588822795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY JOHNS TRUE MFT

Provider Business Mailing Address
First Line	:	3033 MOORPARK AVE
Second Line	:	STE.4
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2521
Country	:	US
Telephone Number	:	408-247-7999
Fax Number	:	408-369-8760

Provider Business Practice Location Address
First Line	:	3033 MOORPARK AVE
Second Line	:	STE.4
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2521
Country	:	US
Telephone Number	:	408-247-7999
Fax Number	:	408-369-8760

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2008
Last Update Date	:	05/26/2008

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