Provider Demographics
NPI:1134930514
Name:YANCEY, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:YANCEY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:Y
Other - Last Name:DEFINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:29 BROAD LEAF TRL
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2072
Mailing Address - Country:US
Mailing Address - Phone:610-350-7485
Mailing Address - Fax:
Practice Address - Street 1:175 STRAFFORD AVE STE 360
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3341
Practice Address - Country:US
Practice Address - Phone:610-350-7485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health