Healthcare Provider Details

I. General information

NPI: 1023541679
Provider Name (Legal Business Name): TRACY WEEGMANN BA, CBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E 9TH AVE SUITE 554
DENVER CO
80203-2736
US

IV. Provider business mailing address

190 E 9TH AVE STE 554
DENVER CO
80203-2730
US

V. Phone/Fax

Practice location:
  • Phone: 720-876-1533
  • Fax:
Mailing address:
  • Phone: 720-876-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0021402
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: