Provider Demographics
NPI:1457183790
Name:NALL, TRACY JEAN
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:JEAN
Last Name:NALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 GOSS ST APT 207
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6566
Mailing Address - Country:US
Mailing Address - Phone:720-775-8443
Mailing Address - Fax:
Practice Address - Street 1:1900 GOSS ST APT 207
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6566
Practice Address - Country:US
Practice Address - Phone:720-775-8443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health