Provider Demographics
NPI:1386067650
Name:BAIRD, TRACI
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:
Last Name:BAIRD
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:BORGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1908 BUSINESS CENTER DR STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3468
Mailing Address - Country:US
Mailing Address - Phone:909-890-5930
Mailing Address - Fax:
Practice Address - Street 1:1908 BUSINESS CENTER DR STE 220
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3468
Practice Address - Country:US
Practice Address - Phone:909-890-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor