Provider Demographics
NPI:1467855015
Name:NELSON, TRACY LYNN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:TUPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:3600 MACLAY BLVD S STE 100
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1276
Practice Address - Country:US
Practice Address - Phone:850-333-1279
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1301103K00000X
FL1-12-12016103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst