Provider Demographics
NPI:1568863686
Name:ABBOTT, TRACIE (MA)
Entity Type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 ACOMA ST UNIT 405
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4042
Mailing Address - Country:US
Mailing Address - Phone:614-404-7708
Mailing Address - Fax:
Practice Address - Street 1:816 ACOMA ST UNIT 405
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4042
Practice Address - Country:US
Practice Address - Phone:614-404-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health