Provider Demographics
NPI:1427221183
Name:KRAUSE, TRACY ALISON (MC, LAC, NCC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ALISON
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:MC, LAC, NCC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ALISON
Other - Last Name:KRAUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3910 S RURAL RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5581
Mailing Address - Country:US
Mailing Address - Phone:480-317-9867
Mailing Address - Fax:480-317-9867
Practice Address - Street 1:3910 S RURAL RD
Practice Address - Street 2:SUITE J
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5581
Practice Address - Country:US
Practice Address - Phone:480-317-9867
Practice Address - Fax:480-317-9867
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13115101YP2500X
NC10328101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional