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General NPI Number Information
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NPI Number | 1760534853
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Entity Type | Individual
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Provider Name | TRACY LILJEQUIST MFT
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 04/26/2008
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Provider Practice Location Address
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Address Line | 2345 E 8TH ST SUITE 103
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2800
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Country | US
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Telephone | 858-354-5514
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Fax | 619-267-9307
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Provider Business Mailing Address
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Address Line | 12636 SARSAPARILLA ST
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City | SAN DIEGO
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State | CA
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Zip | 92129-3735
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Country | US
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Telephone | 858-354-5514
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC42206
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License Number State | CA
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