Provider Demographics
NPI:1841710001
Name:GRANT, TRACY J (MA, LMFT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:J
Last Name:GRANT
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 PERRY ST STE 206C
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2434
Mailing Address - Country:US
Mailing Address - Phone:720-460-1492
Mailing Address - Fax:
Practice Address - Street 1:333 PERRY ST STE 206C
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2434
Practice Address - Country:US
Practice Address - Phone:720-460-1492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001421106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist