MEDICARE: TRACEY ADELE KANE LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	141492	CA

General Provider Information

NPI Number	:	1417709460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY ADELE KANE LMFT

Provider Business Mailing Address
First Line	:	32301 CAMINO CAPISTRANO STE L&K
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-4512
Country	:	US
Telephone Number	:	949-401-4454
Fax Number	:

Provider Business Practice Location Address
First Line	:	32301 CAMINO CAPISTRANO STE L&K
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-4512
Country	:	US
Telephone Number	:	858-382-6134
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	04/30/2024

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