Healthcare Provider Details

I. General information

NPI: 1932348554
Provider Name (Legal Business Name): TRACY MIKAELIAN VALENCIA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4324 W HARVARD AVE
FRESNO CA
93722-5183
US

IV. Provider business mailing address

3524 PRESCOTT AVE
CLOVIS CA
93619-2015
US

V. Phone/Fax

Practice location:
  • Phone: 559-681-1470
  • Fax:
Mailing address:
  • Phone: 559-824-0913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMFC40566
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT40566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: