Active NPI
Tracee Phanco, LMFT
- Marriage & Family Therapist
- Clovis, CA
National Provider Identifier
1528447802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 86023
- Practice address
- 264 Clovis Ave
Suite 211
Clovis, CA 93612-1115 - Phone
- (559) 797-1711
- Fax
- (559) 324-6565
- NPI assigned
- May 20, 2015
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 86023 | CA | Primary |
Addresses
Primary practice location
264 Clovis Ave
Suite 211
Clovis, CA 93612-1115
Mailing address
264 Clovis Ave
Suite 211
Clovis, CA 93612-1115
Phone (559) 797-1711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 18, 2025 through May 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432080000000",
"number": "1528447802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "264 CLOVIS AVE",
"address_2": "SUITE 211",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936121115",
"telephone_number": "559-797-1711",
"fax_number": "559-324-6565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "264 CLOVIS AVE",
"address_2": "SUITE 211",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936121115",
"telephone_number": "559-797-1711",
"fax_number": "559-324-6565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHANCO",
"first_name": "TRACEE",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-20",
"last_updated": "2015-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "86023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clovis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.