Provider Demographics
NPI:1326393901
Name:NAVRIDES, TRACEY LEE (LMFT)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LEE
Last Name:NAVRIDES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 FOX SPRING RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3020
Mailing Address - Country:US
Mailing Address - Phone:818-599-3221
Mailing Address - Fax:
Practice Address - Street 1:415 N CAMDEN DR STE 111
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4436
Practice Address - Country:US
Practice Address - Phone:818-599-3221
Practice Address - Fax:818-279-6365
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51808106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist