Healthcare Provider Details

I. General information

NPI: 1386565406
Provider Name (Legal Business Name): TRACEY PARSON CPRP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W ALLEGHENY AVE
PHILADELPHIA PA
19133-3629
US

IV. Provider business mailing address

1250 FAIRMOUNT AVE
PHILADELPHIA PA
19123-2413
US

V. Phone/Fax

Practice location:
  • Phone: 215-989-1771
  • Fax:
Mailing address:
  • Phone: 215-989-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: