Provider Demographics
NPI:1750706669
Name:TOLLIVER, TRACI (MA, LMFT, LMHC, CMHS)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:TOLLIVER
Suffix:
Gender:F
Credentials:MA, LMFT, LMHC, CMHS
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:RASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21543 W TERRA LN SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-9027
Mailing Address - Country:US
Mailing Address - Phone:253-249-5991
Mailing Address - Fax:360-507-8097
Practice Address - Street 1:106 PLAZA DR SE BLDG B3
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8841
Practice Address - Country:US
Practice Address - Phone:253-249-5991
Practice Address - Fax:360-507-8097
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60890982106H00000X
WALH60749833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health