Provider Demographics
NPI:1720549579
Name:HALL, TRACEY Y (BS BEHAVIORAL SERV,)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:Y
Last Name:HALL
Suffix:
Gender:F
Credentials:BS BEHAVIORAL SERV,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 21ST ST APT BSMT
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3761
Mailing Address - Country:US
Mailing Address - Phone:307-275-5981
Mailing Address - Fax:
Practice Address - Street 1:205 STOREY BLVD STE 120
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-3566
Practice Address - Country:US
Practice Address - Phone:307-459-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician