Provider Demographics
NPI:1609221126
Name:PARKER, TRACEY
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 E MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-1128
Mailing Address - Country:US
Mailing Address - Phone:480-382-0388
Mailing Address - Fax:
Practice Address - Street 1:10240 N 31ST AVE
Practice Address - Street 2:#200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9558
Practice Address - Country:US
Practice Address - Phone:602-395-8147
Practice Address - Fax:602-997-4585
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health