Provider Demographics
NPI:1699179473
Name:RAULS, TRACYE
Entity Type:Individual
Prefix:
First Name:TRACYE
Middle Name:
Last Name:RAULS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:VIOLET HILL
Mailing Address - State:AR
Mailing Address - Zip Code:72584
Mailing Address - Country:US
Mailing Address - Phone:870-373-3031
Mailing Address - Fax:
Practice Address - Street 1:1815 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:VIOLET HILL
Practice Address - State:AR
Practice Address - Zip Code:72584
Practice Address - Country:US
Practice Address - Phone:870-373-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility