Healthcare Provider Details

I. General information

NPI: 1659520088
Provider Name (Legal Business Name): TRACY L KEENE LPC/ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8247 E STOCKTON BLVD
SACRAMENTO CA
95828-8200
US

IV. Provider business mailing address

8247 E STOCKTON BLVD
SACRAMENTO CA
95828-8200
US

V. Phone/Fax

Practice location:
  • Phone: 916-525-6773
  • Fax:
Mailing address:
  • Phone: 916-525-6773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7106
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number98149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: