Provider Demographics
NPI:1992384259
Name:WHITLOCK, TRACIE EYRE
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:EYRE
Last Name:WHITLOCK
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 1:6171 W THORNTON CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3542
Mailing Address - Country:US
Mailing Address - Phone:801-369-8190
Mailing Address - Fax:
Practice Address - Street 1:6171 W THORNTON CIR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-3542
Practice Address - Country:US
Practice Address - Phone:801-369-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist