Provider Demographics
NPI:1407283971
Name:SPRADLING, TRACEY (MA)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:SPRADLING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 BEDFORD DR STE A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1900
Mailing Address - Country:US
Mailing Address - Phone:321-259-1662
Mailing Address - Fax:321-259-1223
Practice Address - Street 1:1299 BEDFORD DR STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1900
Practice Address - Country:US
Practice Address - Phone:321-259-1662
Practice Address - Fax:321-259-1223
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor