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General NPI Number Information
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NPI Number | 1750827499
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Entity Type | Organization
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Legal Business Name | TRACY WUTZKE, PSY.D
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Dates
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Enumeration Date | 01/18/2017
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Last Update Date | 11/14/2021
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Provider Practice Location Address
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Address Line | 9888 CARROLL CENTRE RD STE 216
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City | SAN DIEGO
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State | CA
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Zip | 92126-4515
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Country | US
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Telephone | 858-413-7557
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Fax | 858-217-5285
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Provider Business Mailing Address
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Address Line | 9888 CARROLL CENTRE RD STE 216
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City | SAN DIEGO
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State | CA
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Zip | 92126-4515
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Country | US
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Telephone | 858-413-7557
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Fax | 858-217-5285
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. TRACY WUTZKE
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Credential | PSY.D
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Telephone | 858-413-7557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 52458
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY17239
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License Number State | CA
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