Healthcare Provider Details

I. General information

NPI: 1215182084
Provider Name (Legal Business Name): TRACY LEE ANN DURHAM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACY LEE ANN DURHAM PHD

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ANDEWS AVE.
FT. RUCKER AL
36362-5333
US

IV. Provider business mailing address

301 ANDEWS AVE.
FT. RUCKER AL
36362-5333
US

V. Phone/Fax

Practice location:
  • Phone: 800-261-7193
  • Fax:
Mailing address:
  • Phone: 800-261-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1527
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: