Healthcare Provider Details

I. General information

NPI: 1376480624
Provider Name (Legal Business Name): TRACY LYNN SOCKRITER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W HIGHLAND AVE
FLORENCE CO
81226-9596
US

IV. Provider business mailing address

107 S 9TH ST
CANON CITY CO
81212-3800
US

V. Phone/Fax

Practice location:
  • Phone: 303-667-7167
  • Fax:
Mailing address:
  • Phone: 719-430-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADDC.0000646
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: