Healthcare Provider Details

I. General information

NPI: 1902275704
Provider Name (Legal Business Name): TRACY HOWARD SELLS B.S. NEUROSCIENCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S VIRGINIA ST 91
RENO NV
89502-2413
US

IV. Provider business mailing address

805 S VIRGINIA ST 91
RENO NV
89502-2413
US

V. Phone/Fax

Practice location:
  • Phone: 775-412-5769
  • Fax:
Mailing address:
  • Phone: 775-412-5769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: