Provider Demographics
NPI:1679744353
Name:GANSEL, TRACEY (BS)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:
Last Name:GANSEL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 TINY TOWN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-5809
Mailing Address - Country:US
Mailing Address - Phone:931-431-7580
Mailing Address - Fax:931-431-7583
Practice Address - Street 1:800 TINY TOWN RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-5809
Practice Address - Country:US
Practice Address - Phone:931-431-7580
Practice Address - Fax:931-431-7583
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator