Provider Demographics
NPI:1336448455
Name:TRACY, VICTORIA LEIGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:LEIGH
Last Name:TRACY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3532 S TROOST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2647
Mailing Address - Country:US
Mailing Address - Phone:918-857-0321
Mailing Address - Fax:
Practice Address - Street 1:7146 S BRADEN AVE STE 700
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6335
Practice Address - Country:US
Practice Address - Phone:918-878-8072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1352103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical