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General NPI Number Information
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NPI Number | 1184508079
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Entity Type | Organization
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Legal Business Name | TRACE AND HEAL THERAPY LLC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 27201 TOURNEY RD STE 201K
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City | VALENCIA
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State | CA
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Zip | 91355-1804
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Country | US
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Telephone | 818-438-8896
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Fax |
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Provider Business Mailing Address
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Address Line | 27305 LIVE OAK ROAD SUITE A #614
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City | CASTAIC
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State | CA
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Zip | 91384
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Country | US
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Telephone | 818-438-8896
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JOSHUA ROSARIO
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Credential |
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Telephone | 818-438-8896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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