Provider Demographics
NPI:1831695741
Name:CUNNINGHAM, TRACEY L
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:CUNNINGHAM
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 1:750 N 143RD ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6944
Mailing Address - Country:US
Mailing Address - Phone:206-313-2687
Mailing Address - Fax:
Practice Address - Street 1:2329 4TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1717
Practice Address - Country:US
Practice Address - Phone:206-461-3649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-01
Last Update Date:2018-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor