Provider Demographics
NPI:1114433364
Name:FUCHS, TRACY LANE (CMHC, ASUDC)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:LANE
Last Name:FUCHS
Suffix:
Gender:M
Credentials:CMHC, ASUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 W 1200 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2607
Mailing Address - Country:US
Mailing Address - Phone:801-301-9703
Mailing Address - Fax:
Practice Address - Street 1:145 S 200 E
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-2047
Practice Address - Country:US
Practice Address - Phone:801-784-9455
Practice Address - Fax:888-876-2112
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3083074-6008101YA0400X
UT3083074-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT3083074-6004OtherDIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING
UT3083074-6008OtherDIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING