Healthcare Provider Details

I. General information

NPI: 1922521848
Provider Name (Legal Business Name): TRACY L CHU-HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2017
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WILLOW PASS RD # 200
CONCORD CA
94520-5823
US

IV. Provider business mailing address

1420 WILLOW PASS RD # 200
CONCORD CA
94520-5823
US

V. Phone/Fax

Practice location:
  • Phone: 925-521-5100
  • Fax:
Mailing address:
  • Phone: 925-521-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number84304
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: