Provider Demographics
NPI:1265260988
Name:TRACEY M. ALLAN, PH.D., LLC
Entity type:Organization
Organization Name:TRACEY M. ALLAN, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:MUGRAGE
Authorized Official - Last Name:ALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:989-835-1174
Mailing Address - Street 1:211 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-3350
Mailing Address - Country:US
Mailing Address - Phone:989-835-1174
Mailing Address - Fax:989-423-1525
Practice Address - Street 1:211 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-3350
Practice Address - Country:US
Practice Address - Phone:989-835-1174
Practice Address - Fax:989-423-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health