Healthcare Provider Details

I. General information

NPI: 1528620424
Provider Name (Legal Business Name): TRACY TSAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 ANNAPOLIS RD
LANHAM MD
20706-3115
US

IV. Provider business mailing address

9301 ANNAPOLIS RD
LANHAM MD
20706-3115
US

V. Phone/Fax

Practice location:
  • Phone: 240-296-6300
  • Fax:
Mailing address:
  • Phone: 240-296-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP9593
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: