Provider Demographics
NPI:1982973053
Name:TRACEY R. FINTEL, PHD, LLC
Entity Type:Organization
Organization Name:TRACEY R. FINTEL, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FINTEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-725-1515
Mailing Address - Street 1:9890 CLAYTON RD
Mailing Address - Street 2:SUITE 133
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1685
Mailing Address - Country:US
Mailing Address - Phone:314-725-1515
Mailing Address - Fax:314-222-6321
Practice Address - Street 1:9890 CLAYTON RD
Practice Address - Street 2:SUITE 133
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1685
Practice Address - Country:US
Practice Address - Phone:314-725-1515
Practice Address - Fax:314-222-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC1185766103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty