Provider Demographics
NPI:1770028904
Name:TRACEY, JAMIE (LAMFT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:TRACEY
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6874
Mailing Address - Country:US
Mailing Address - Phone:575-434-3011
Mailing Address - Fax:
Practice Address - Street 1:3024 LOS ROBLES
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-3964
Practice Address - Country:US
Practice Address - Phone:575-442-1357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-25
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-CTL0205341101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor