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General NPI Number Information
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NPI Number | 1063397149
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Entity Type | Organization
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Legal Business Name | TRACEY WALTERS LLC
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 614 W MANCHESTER BLVD # 201-202
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City | INGLEWOOD
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State | CA
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Zip | 90301-1656
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Country | US
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Telephone | 323-363-2069
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 882588
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City | LOS ANGELES
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State | CA
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Zip | 90009-3626
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Country | US
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Telephone | 323-363-2069
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Fax |
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Authorized Official
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Title or Position | PEER SUPPORT SPECIALIST
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Name | MS. TRACEY WALTERS
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Credential |
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Telephone | 323-363-2069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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