Provider Demographics
NPI:1336157452
Name:CRABB, TRACI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TRACI
Middle Name:
Last Name:CRABB
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 1:3775 N EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5005
Mailing Address - Country:US
Mailing Address - Phone:208-938-9653
Mailing Address - Fax:208-938-1399
Practice Address - Street 1:3775 N EAGLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5005
Practice Address - Country:US
Practice Address - Phone:208-938-9653
Practice Address - Fax:208-938-1399
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY - 202233103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010157338OtherREGENCE BLUE SHIELD OF ID
IDN6289OtherBLUE CROSS OF IDAHO
ID806968300Medicaid