Provider Demographics
NPI:1205083961
Name:THOMAS, TRACEY (PSYD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 621715
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32862-1715
Mailing Address - Country:US
Mailing Address - Phone:407-748-4869
Mailing Address - Fax:
Practice Address - Street 1:6001 BRICK CT
Practice Address - Street 2:STE 109
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9425
Practice Address - Country:US
Practice Address - Phone:407-748-4869
Practice Address - Fax:407-429-3923
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health