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General NPI Number Information
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NPI Number | 1023555158
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Entity Type | Individual
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Provider Name | TRACY RAE ISAAC APCC, LPHA, CATC IV
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Gender | Female
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 3286 E GUASTI RD STE 100-110
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City | ONTARIO
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State | CA
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Zip | 91761-8645
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Country | US
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Telephone | 909-241-8594
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Fax |
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Provider Business Mailing Address
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Address Line | 3286 E GUASTI RD STE 100
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City | ONTARIO
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State | CA
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Zip | 91761-8646
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Country | US
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Telephone | 909-906-9844
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12043
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License Number State | CA
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