Healthcare Provider Details

I. General information

NPI: 1487990552
Provider Name (Legal Business Name): TRACY HOVE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4689 CEDAR CT
PARK CITY UT
84098-5162
US

IV. Provider business mailing address

4689 CEDAR CT
PARK CITY UT
84098-5162
US

V. Phone/Fax

Practice location:
  • Phone: 801-884-3926
  • Fax:
Mailing address:
  • Phone: 801-884-3926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7915077-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: