MEDICARE: MS. TRACIE LYNETTE HARDY

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	175T00000X	Peer Specialist		CA

General Provider Information

NPI Number	:	1871442046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACIE LYNETTE HARDY

Provider Business Mailing Address
First Line	:	3870 CRENSHAW BLVD STE 212
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1815
Country	:	US
Telephone Number	:	562-480-9112
Fax Number	:

Provider Business Practice Location Address
First Line	:	3870 CRENSHAW BLVD STE 212
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1815
Country	:	US
Telephone Number	:	562-480-9112
Fax Number	:

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

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	03/02/2026

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