Provider Demographics
NPI:1467901728
Name:AGUILAR, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 S ALMA SCHOOL RD STE 21
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7077
Mailing Address - Country:US
Mailing Address - Phone:323-670-0987
Mailing Address - Fax:323-670-0987
Practice Address - Street 1:2040 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-7075
Practice Address - Country:US
Practice Address - Phone:323-670-0987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS206421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical