| Wutzke, Tracy | |
|
9888 Carroll Centre Rd Ste 216 San Diego CA 92126-4515 | |
| (858) 413-7557 | |
| (858) 217-5285 |
| Full Name | Wutzke, Tracy |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 9888 Carroll Centre Rd Ste 216, San Diego, California |
| Authorized Official Name and Position | Tracy Wutzke (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8584137557 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wutzke, Tracy 9888 Carroll Centre Rd Ste 216 San Diego CA 92126-4515 Ph: (858) 413-7557 | Wutzke, Tracy 9888 Carroll Centre Rd Ste 216 San Diego CA 92126-4515 Ph: (858) 413-7557 |
| NPI Number | 1750827499 |
|---|---|
| Provider Enumeration Date | 01/18/2017 |
| Last Update Date | 11/14/2021 |
| Certification Date | 11/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750827499 | NPI | - | NPPES |
| 100058167001 | Other | CA | BLUE SHIELD OF CALIFORNIA |
| 240986 | Other | CA | MHN |
| 134599523187 | Other | CA | HUMANA |
| 0009236145 | Other | CA | AETNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY17239 (California) | Primary |
| 106H00000X | Marriage & Family Therapist | 52458 (California) | Secondary |
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