Provider Demographics
NPI:1598933236
Name:HOGAN, TRACY (CMHC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10949 S KESTREL RISE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-6216
Mailing Address - Country:US
Mailing Address - Phone:720-243-3512
Mailing Address - Fax:801-302-7248
Practice Address - Street 1:10432 S 4000 W STE B
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-5729
Practice Address - Country:US
Practice Address - Phone:720-243-3512
Practice Address - Fax:801-905-6411
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10865116-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health