Provider Demographics
NPI:1013284686
Name:ROYER, TRACY JEAN
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:JEAN
Last Name:ROYER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TJ
Other - Middle Name:JEAN
Other - Last Name:ROYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:809 COOKSON ST
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7369
Mailing Address - Country:US
Mailing Address - Phone:707-449-6377
Mailing Address - Fax:
Practice Address - Street 1:1017 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4547
Practice Address - Country:US
Practice Address - Phone:707-647-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)