Provider Demographics
NPI:1700112281
Name:WRIGHT, TRACY CAREN (MS)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:CAREN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34316 BLACK BASS CIR
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-6304
Mailing Address - Country:US
Mailing Address - Phone:352-326-8096
Mailing Address - Fax:
Practice Address - Street 1:34316 BLACK BASS CIR
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-6304
Practice Address - Country:US
Practice Address - Phone:352-326-8096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH7672101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor