Provider Demographics
NPI:1538045596
Name:GRAHAM-RICE, TRACY LAINE (LEP, PPS)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LAINE
Last Name:GRAHAM-RICE
Suffix:
Gender:F
Credentials:LEP, PPS
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:LAINE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2721 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2618
Mailing Address - Country:US
Mailing Address - Phone:213-999-9592
Mailing Address - Fax:
Practice Address - Street 1:1401 FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-6204
Practice Address - Country:US
Practice Address - Phone:213-999-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3658103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist