| Doctor Name: | TRACY DERN |
| NPI Number: | 1215121678 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYCH |
| License Number: | PSY20534 |
| Business Practice Address: | 24511 W Jayne Ave Coalinga, CA - 932109503 |
| Business Phone Number: | 5599354301 |
| Business Fax Number: | 5599357118 |
| Mailing Address: | 1600 9th St, Room 205 Mailstop 2-3 SACRAMENTO |
| State: | CA |
| Postal Code: | 958146404 |
| Phone Number: | 9166542431 |
| Fax Number: | 9166543186 |
| NPI Enumeration Date: | 08/29/2007 |
| NPI Last Update Date: | 08/29/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TF0200X |
| License Number: | PSY20534 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Forensic |
| Taxonomy Definition: | |