Provider Demographics
NPI:1568887073
Name:STEVENS, TRACIE JOELENE (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:JOELENE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:JOELENE
Other - Last Name:CONNORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1009 N BLUE TOPAZ DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-3035
Mailing Address - Country:US
Mailing Address - Phone:435-632-9514
Mailing Address - Fax:
Practice Address - Street 1:1009 N BLUE TOPAZ DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-3035
Practice Address - Country:US
Practice Address - Phone:435-632-9514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9436174-35021041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical