Provider Demographics
NPI:1073818860
Name:HICKS, TRACEY L (MCJ)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:HICKS
Suffix:
Gender:F
Credentials:MCJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 W LONE CACTUS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8329
Mailing Address - Country:US
Mailing Address - Phone:480-819-3249
Mailing Address - Fax:
Practice Address - Street 1:9250 W LONE CACTUS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8329
Practice Address - Country:US
Practice Address - Phone:480-819-3249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst