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NPI Code Detail

MEDICARE: DR. TRACY JO DRAHOTA PSYD

MEDICARE: DR. TRACY JO DRAHOTA PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist3289OR
2103TC0700XClinical PsychologistPSY-004145AZ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2Z327625OTHERAZMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134425929
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRACY JO DRAHOTA PSYD
Provider Business Mailing Address
First Line : 3033 N CENTRAL AVE STE 145
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2808
Country : US
Telephone Number : 623-583-3001
Fax Number :
Provider Business Practice Location Address
First Line : 9610 N METRO PKWY W
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-1402
Country : US
Telephone Number : 480-964-2273
Fax Number : 602-843-1560
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2011
Last Update Date : 05/02/2025

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