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NPI Code Detail

MEDICARE: MRS. TRACY ANN HOLCOMB BRACKIN MFT

MEDICARE:  MRS. TRACY ANN HOLCOMB BRACKIN  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
1106H00000XMarriage & Family Therapist62576CA

General Provider Information

NPI Number : 1962534594
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACY ANN HOLCOMB BRACKIN MFT
Provider Business Mailing Address
First Line : 9217 SOPHIA AVE
Second Line :
City : NORTH HILLS
State : CA
Zip : 91343-3811
Country : US
Telephone Number : 818-891-4361
Fax Number : 818-347-0184
Provider Business Practice Location Address
First Line : 4900 SERRANIA AVE
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91364-3301
Country : US
Telephone Number : 818-657-3143
Fax Number : 818-347-0184
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2007
Last Update Date : 11/18/2020

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Directions to “ MRS. TRACY ANN HOLCOMB BRACKIN MFT” Practice Location

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