Provider Demographics
NPI:1598908964
Name:JEFFRIES, TRACY ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ANN
Last Name:JEFFRIES
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 1:1430 WILLAMETTE ST # 140
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4049
Mailing Address - Country:US
Mailing Address - Phone:541-255-1411
Mailing Address - Fax:541-255-1412
Practice Address - Street 1:1599 OAK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4008
Practice Address - Country:US
Practice Address - Phone:541-255-1411
Practice Address - Fax:541-255-1412
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
ORR7020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500663796Medicaid