Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 3148 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3148 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | 3148 | CA |
Y | 103TS0200X | School Psychologist | 3148 | CA |
NPI | 1174040679 |
---|---|
Provider Name | Ms. Tracine Renee Hallum |
First Address | Bakersfield, CA 93309-4223 |
Second Address | Bakersfield, CA 93301-4907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2017 |
Last Update Date | 25/08/2017 |