Provider Demographics
NPI:1740637891
Name:COOPER, TRACY ULOMA
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ULOMA
Last Name:COOPER
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 1:2834 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4422
Mailing Address - Country:US
Mailing Address - Phone:760-534-1335
Mailing Address - Fax:
Practice Address - Street 1:2834 E 4TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4422
Practice Address - Country:US
Practice Address - Phone:760-534-1335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor