Provider Demographics
NPI:1518465913
Name:ROSVALL, TRACI (PHD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:ROSVALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 PRESTON RD STE 350
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1240
Mailing Address - Country:US
Mailing Address - Phone:972-250-1705
Mailing Address - Fax:972-250-1710
Practice Address - Street 1:17000 PRESTON RD STE 350
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1240
Practice Address - Country:US
Practice Address - Phone:972-250-1705
Practice Address - Fax:972-250-1710
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37317103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical