Provider Demographics
NPI:1932211471
Name:BRADY, TRACIE LYNN (FSP)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:LYNN
Last Name:BRADY
Suffix:
Gender:F
Credentials:FSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10344 BIRKENHEAD RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7504
Mailing Address - Country:US
Mailing Address - Phone:405-262-3209
Mailing Address - Fax:405-262-1331
Practice Address - Street 1:200 N CHOCTAW AVE STE 140
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2640
Practice Address - Country:US
Practice Address - Phone:405-388-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health