Provider Demographics
NPI:1407970452
Name:TRACY, CELESTIA GAY
Entity Type:Individual
Prefix:MRS
First Name:CELESTIA
Middle Name:GAY
Last Name:TRACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CELESTIA
Other - Middle Name:GAY
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:1830 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3056
Mailing Address - Country:US
Mailing Address - Phone:480-730-6222
Mailing Address - Fax:480-730-5929
Practice Address - Street 1:1830 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 112
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3056
Practice Address - Country:US
Practice Address - Phone:480-730-6222
Practice Address - Fax:480-730-5929
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCC-1827101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional