Healthcare Provider Details

I. General information

NPI: 1629200712
Provider Name (Legal Business Name): TRACY MINGLI ONG PH.D., BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2009
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BELLEVUE AVE STE 201B
OAKLAND CA
94610-4923
US

IV. Provider business mailing address

1781 HELANE CT
BENICIA CA
94510-2659
US

V. Phone/Fax

Practice location:
  • Phone: 866-381-1668
  • Fax: 866-381-1668
Mailing address:
  • Phone: 866-381-1668
  • Fax: 866-381-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY24777
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: