Provider Demographics
NPI:1326598376
Name:BURKHART, TRACY (MA, MEDIATOR)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BURKHART
Suffix:
Gender:F
Credentials:MA, MEDIATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E COSTILLA STREET
Mailing Address - Street 2:STE 22
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903
Mailing Address - Country:US
Mailing Address - Phone:719-301-9373
Mailing Address - Fax:
Practice Address - Street 1:303 E COSTILLA STREET
Practice Address - Street 2:STE 22
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:719-301-9373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health