Provider Demographics
NPI:1558844225
Name:NICOLL, TRACIE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:A
Last Name:NICOLL
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 1:110 CHANTREY CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4395
Mailing Address - Country:US
Mailing Address - Phone:719-232-5223
Mailing Address - Fax:719-487-9530
Practice Address - Street 1:1843 AUSTIN BLUFFS PKWY STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7857
Practice Address - Country:US
Practice Address - Phone:719-232-5223
Practice Address - Fax:719-487-9530
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4860103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty