Active NPI
Tracy A Williamson
- Clinical Psychologist
- Irvine, CA
National Provider Identifier
1285834424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY18060
- Practice address
- 300 Spectrum Dr.
Irvine, CA 92618 - Phone
- (949) 201-9147
- NPI assigned
- Jul 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY18060 | CA | Primary |
Addresses
Primary practice location
300 Spectrum Dr.
Irvine, CA 92618
Mailing address
5901 Victory CT
Fairfield, CA 94533-9747
Phone (949) 201-9147
Other practice location 1
4199 Campus Dr
Ste. 200
Irvine, CA 92612-4684
Phone (949) 510-9014
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285834424 | Other | CA | NPI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY18060 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Talk Therapy Center | Current | Accepting new patients |
Locations
19322 Jesse Ln
Ste 200
Riverside, CA 92508
Phone (951) 387-4040
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Marriage & Family Therapist
- Riverside, CA
- NPI 1174089411
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1285834424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5901 VICTORY CT",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945339747",
"telephone_number": "949-201-9147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 SPECTRUM DR.",
"city": "IRVINE",
"state": "CA",
"postal_code": "92618",
"telephone_number": "949-201-9147"
}
],
"practiceLocations": [
{
"address_1": "4199 Campus Dr",
"address_2": "Ste. 200",
"address_purpose": "LOCATION",
"city": "Irvine",
"state": "CA",
"postal_code": "926124684",
"country_code": "US",
"telephone_number": "949-510-9014",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILLIAMSON",
"first_name": "TRACY",
"middle_name": "A",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-07-24",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18060",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1285834424",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.