TRACEY BLACK (NPI# 1740893155) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740893155 |
| Entity Type | Individual |
| Full Name | TRACEY BLACK |
| Practice Address |
130 W Flora St Stockton CA 95202-1636 |
| Mailing Address |
538 N Lincoln Ave Manteca CA 95336-3940 |
| Practice Telephone | 9254133861 |
| Mailing Telephone | 2096797309 |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2020-08-25 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
C041740417 | CA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326551748 | Tracey Black | Counselor | 1333 Iris Ave, Boulder, CO 80304-2226 | 2017-11-07 |
| Street Address |
130 W FLORA ST |
| City | STOCKTON |
| State | CA |
| Zip Code | 95202-1636 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881291557 | Bill Walls Iv | Counselor | 130 W Flora St, Stockton, CA 95202-1636 | 2020-10-06 |
| 1881291854 | Julie Rae Moralez | Counselor | 130 W Flora St, Stockton, CA 95202-1636 | 2020-10-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336774678 | Lecletus Griffin Jr. | Counselor | 1212 N. Califronia Street, Stockton, CA 95202 | 2020-03-06 |
| 1861035586 | Andrea Mn Perkins | Social Worker | Sjc Bhs Bacop, 1149 El Dorado Street, Stockton, CA 95202 | 2019-10-25 |
| 1932664620 | San Joaquin County Behavioral Health Services | Community/Behavioral Health | 1212 N. Califorian St, Stockton, CA 95202 | 2019-02-06 |
| 1730655895 | Jenaiah La'neise Sauceda | Social Worker | 343 E Main St Ste 918, Stockton, CA 95202 | 2018-10-16 |
| 1235631722 | Parker Yang | Counselor | 1111 N. El Dorado St, Stockton, CA 95202 | 2018-03-01 |
| 1912406976 | Janet Mendoza | Social Worker | 6 South Eldorado Street, Stockton, CA 95202 | 2018-02-06 |
| 1487162087 | Linda Soun | Counselor | 1111 N. El Dorado Street, Stockton, CA 95202 | 2018-01-17 |
| 1124545355 | Suleyma Velesquez | Counselor | 445 N. San Joaquin St., Stockton, CA 95202 | 2017-08-28 |
| 1821513946 | Savoeun Phal | Counselor | 1212 N California St Ste A214, Stockton, CA 95202 | 2017-08-09 |
| 1861921272 | Mandeep K Minhas | Registered Nurse | 1212 California St, Stockton, CA 95202 | 2017-06-08 |
| Find all providers in zip 95202 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699305508 | Juan Robles | Counselor | 1947 N California St # 95204, Stockton, CA 95204-6029 | 2020-01-20 |
| 1831730555 | Ronnie C Murray | Counselor | 1947 North California Street, Stockton, CA 95204 | 2019-10-03 |
| 1821648353 | Kaye Lynn Scott-roy | Counselor | 285 H Rd, Stockton, KS 67669-8889 | 2019-09-17 |
| 1760049043 | Jay Frank Williams | Counselor | 1105 N El Dorado St, Stockton, CA 95202-1305 | 2019-05-22 |
| 1184105462 | Rachelle Diane Wilson | Counselor | 2733 N Sutter St, Stockton, CA 95204-4548 | 2018-08-24 |
| 1568943835 | Heather Lynn Rogers | Counselor | 3990 Black Butte Cir, Stockton, CA 95209-3500 | 2018-08-24 |
| 1235631722 | Parker Yang | Counselor | 1111 N. El Dorado St, Stockton, CA 95202 | 2018-03-01 |
| 1487162087 | Linda Soun | Counselor | 1111 N. El Dorado Street, Stockton, CA 95202 | 2018-01-17 |
| 1760995781 | Dana Lamont Harris | Counselor | 2833 Buckner Ct, Stockton, CA 95207-2302 | 2017-11-13 |
| 1023520590 | Derek Michael Sauceda | Counselor | 1222 Monaco Ct Ste 28, Stockton, CA 95207-6742 | 2017-10-24 |
| Find all providers in STOCKTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.