Provider Demographics
NPI:1558404178
Name:JUNGKURTH, TRACIA HUGHES (PHD, LPC, LMHC)
Entity Type:Individual
Prefix:DR
First Name:TRACIA
Middle Name:HUGHES
Last Name:JUNGKURTH
Suffix:
Gender:F
Credentials:PHD, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37121-0555
Mailing Address - Country:US
Mailing Address - Phone:615-636-7414
Mailing Address - Fax:866-799-4512
Practice Address - Street 1:313B W DIVISION ST
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3207
Practice Address - Country:US
Practice Address - Phone:615-636-7414
Practice Address - Fax:866-799-4512
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1827101YM0800X
FLMH9523101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH9523OtherMENTAL HEALTH COUNSELOR
TN1827OtherLPC MHSP
TN1827OtherLPC MHSP