Provider Demographics
NPI:1891430914
Name:AVERY, TRACY (CSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12043 S EL CAPITAN LN
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-5835
Mailing Address - Country:US
Mailing Address - Phone:801-842-1492
Mailing Address - Fax:
Practice Address - Street 1:12427 S PASTURE RD STE 102
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-5608
Practice Address - Country:US
Practice Address - Phone:801-208-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health