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Organization
TRACY WUTZKE, PSY.D
Active
Organization
TRACY WUTZKE, PSY.D
Active
Other names
Wutzke, Tracy, Dr. Tracy Wutzke
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY WUTZKE PSY.D (CLINICAL PSYCHOLOGIST)
(858) 413-7557
Entity
Organization
Contact information
Practice address
9888 CARROLL CENTRE RD STE 216, SAN DIEGO, CA 92126-4515
(858) 413-7557
(858) 217-5285
Mailing address
9888 CARROLL CENTRE RD STE 216, SAN DIEGO, CA 92126-4515
(858) 413-7557
(858) 217-5285
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY17239
CA
106H00000X
Marriage & Family Therapist
52458
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009236145
AETNA
CA
01
—
100058167001
BLUE SHIELD OF CALIFORNIA
CA
01
—
134599523187
HUMANA
CA
01
—
240986
MHN
CA
Enumeration date
01/18/2017
Last updated
11/14/2021
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