Provider Demographics
NPI:1548586605
Name:TRACY, ROBIN MAY (LPC)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:MAY
Last Name:TRACY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E 4500 S
Mailing Address - Street 2:260
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3991
Mailing Address - Country:US
Mailing Address - Phone:801-747-3556
Mailing Address - Fax:
Practice Address - Street 1:345 E 4500 S
Practice Address - Street 2:260
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3991
Practice Address - Country:US
Practice Address - Phone:801-747-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT269285-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health