Provider Demographics
NPI:1962534594
Name:HOLCOMB BRACKIN, TRACY ANN (MFT)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ANN
Last Name:HOLCOMB BRACKIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9217 SOPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3811
Mailing Address - Country:US
Mailing Address - Phone:818-891-4361
Mailing Address - Fax:818-347-0184
Practice Address - Street 1:4900 SERRANIA AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-3301
Practice Address - Country:US
Practice Address - Phone:818-657-3143
Practice Address - Fax:818-347-0184
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist