Provider Demographics
NPI:1447407408
Name:MOORE-MERRELL, TRACY S (MFT-I, PSYD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:S
Last Name:MOORE-MERRELL
Suffix:
Gender:F
Credentials:MFT-I, PSYD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:S
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT-I, PSYD
Mailing Address - Street 1:304 S JONES BLVD STE 264
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2623
Mailing Address - Country:US
Mailing Address - Phone:702-815-9494
Mailing Address - Fax:702-553-3417
Practice Address - Street 1:304 S JONES BLVD STE 264
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2623
Practice Address - Country:US
Practice Address - Phone:702-815-9494
Practice Address - Fax:702-553-3417
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NVMI0875106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health