Healthcare Provider Details

I. General information

NPI: 1326345216
Provider Name (Legal Business Name): TRACY L MARKLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 PEARL ST STE 305
BOULDER CO
80302-4671
US

IV. Provider business mailing address

2299 PEARL ST STE 305
BOULDER CO
80302-4671
US

V. Phone/Fax

Practice location:
  • Phone: 303-588-9089
  • Fax:
Mailing address:
  • Phone: 303-588-9089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3258
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3258
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: