Healthcare Provider Details

I. General information

NPI: 1518105154
Provider Name (Legal Business Name): TRACY MCWILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4944 E CLINTON WAY 101
FRESNO CA
93727-1527
US

IV. Provider business mailing address

9240 18TH AVE
LEMOORE CA
93245-9558
US

V. Phone/Fax

Practice location:
  • Phone: 559-935-4900
  • Fax: 559-934-1657
Mailing address:
  • Phone: 559-410-2538
  • Fax: 559-934-1657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: