| Tracee Diaz, | |
|
2060 Campus Dr, Yreka, CA 96097-9538 | |
| (530) 841-4770 | |
| Not Available |
| Full Name | Tracee Diaz |
|---|---|
| Gender | Female |
| Speciality | Marriage & Family Therapist |
| Location | 2060 Campus Dr, Yreka, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942633888 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | LMFT95960 (California) | Primary |
| 106H00000X | Marriage & Family Therapist | IMF78303 (California) | Secondary |
| Entity Name | Karuk Tribe |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1730279423 PECOS PAC ID: 4688668387 Enrollment ID: O20040414000866 |
| Mailing Address | Practice Location Address |
|---|---|
| Tracee Diaz, 818 S Main St, Yreka, CA 96097-3321 Ph: (530) 841-4100 | Tracee Diaz, 2060 Campus Dr, Yreka, CA 96097-9538 Ph: (530) 841-4770 |
Shannon Clymer, LCSW77167 Couples Therapy Medicare: Accepting Medicare Assignments Practice Location: 2060 Campus Dr, Yreka, CA 96097 Phone: 530-841-4100 | |
Mr. Bruce Byron Crawford, MFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 2060 Campus Dr, Yreka, CA 96097 Phone: 707-621-1863 | |
Watha Mcleain Dubonnet, MFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 2060 Campus Dr, Yreka, CA 96097 Phone: 530-841-4852 Fax: 530-841-4881 | |
Fausto Poza Jr., LMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 2060 Campus Dr, Yreka, CA 96097 Phone: 530-841-4836 | |
Mr. William K Thompson, MFTI Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 2060 Campus Dr, Yreka, CA 96097 Phone: 530-841-4100 Fax: 530-841-4299 | |
Mr. Steven Dale Waggoner, MA Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 2060 Campus Dr, Yreka, CA 96097 Phone: 530-841-4100 | |
Mrs. Judith Diane Manfredi, MS, LMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 2060 Campus Dr, Yreka, CA 96097 Phone: 530-643-3122 |