Provider Demographics
NPI:1215182084
Name:DURHAM, TRACY LEE ANN (PHD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE ANN
Last Name:DURHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LEE ANN
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1451 ALA AOLANI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1404
Mailing Address - Country:US
Mailing Address - Phone:808-433-6060
Mailing Address - Fax:808-433-1466
Practice Address - Street 1:1451 ALA AOLANI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1404
Practice Address - Country:US
Practice Address - Phone:808-433-6060
Practice Address - Fax:808-433-1466
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1527103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical