Traci Ann Autry, LMFT | |
285 South St, Suite J, San Luis Obispo, CA 93401-5037 | |
(805) 547-7025 | |
Not Available |
Full Name | Traci Ann Autry |
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Gender | Female |
Speciality | Marriage & Family Therapist |
Location | 285 South St, San Luis Obispo, California |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1164803441 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
106H00000X | Marriage & Family Therapist | 80459 (California) | Secondary |
106H00000X | Marriage & Family Therapist | LMFT95987 (California) | Primary |
Entity Name | Wilshire Connected Care |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1104392885 PECOS PAC ID: 5890038558 Enrollment ID: O20190521000171 |
Mailing Address | Practice Location Address |
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Traci Ann Autry, LMFT 285 South St, Suite J, San Luis Obispo, CA 93401-5037 Ph: (805) 547-7025 | Traci Ann Autry, LMFT 285 South St, Suite J, San Luis Obispo, CA 93401-5037 Ph: (805) 547-7025 |
Bethany J Shakespeare, MS, LMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 2975 Mcmillan Ave Ste 164, San Luis Obispo, CA 93401 Phone: 805-439-4890 | |
Callie Rose Boller, Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 2178 Johnson Ave, San Luis Obispo, CA 93401 Phone: 805-781-4700 | |
Susie Juliana Bautista, Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 2178 Johnson Ave, San Luis Obispo, CA 93401 Phone: 805-781-4960 | |
Nasseem Amelia Berkman, Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 2975 Mcmillan Ave Ste 160, San Luis Obispo, CA 93401 Phone: 805-781-4855 | |
Ms. Lynn N. Swanson, LMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 11573 Los Osos Valley Rd, Suite D, San Luis Obispo, CA 93405 Phone: 805-541-1434 | |
Pamela Kremza, LMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 508 Higuera St, San Luis Obispo, CA 93401 Phone: 626-991-0047 | |
Michael Kington, Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 1103 Toro St, San Luis Obispo, CA 93401 Phone: 805-781-4190 |