Provider Demographics
NPI:1548564370
Name:ANDERSON, TRACEY JONES (RN, LPC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:JONES
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 POINT OF THE PINES DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-8144
Mailing Address - Country:US
Mailing Address - Phone:719-593-5853
Mailing Address - Fax:
Practice Address - Street 1:301 AUSTIN BLUFFS PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3922
Practice Address - Country:US
Practice Address - Phone:719-535-0969
Practice Address - Fax:719-598-1168
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-09
Last Update Date:2011-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional