Healthcare Provider Details

I. General information

NPI: 1528897014
Provider Name (Legal Business Name): TRACEY N WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date: 10/02/2025
Reactivation Date: 10/23/2025

III. Provider practice location address

4725 1ST ST STE 262
PLEASANTON CA
94566-7489
US

IV. Provider business mailing address

1623 PEACHTREE CMN
LIVERMORE CA
94551-1470
US

V. Phone/Fax

Practice location:
  • Phone: 925-417-8733
  • Fax:
Mailing address:
  • Phone: 408-215-8705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: