Provider Demographics
NPI:1407479785
Name:CUMBIE, TRACIE ANN (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:ANN
Last Name:CUMBIE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 CECIL G COSTIN SR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-1754
Mailing Address - Country:US
Mailing Address - Phone:850-227-6194
Mailing Address - Fax:
Practice Address - Street 1:528 CECIL G COSTIN SR BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1754
Practice Address - Country:US
Practice Address - Phone:850-227-6194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-17-27127103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst