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General NPI Number Information
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NPI Number | 1528251097
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Entity Type | Individual
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Provider Name | TRACEY M ALLAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/19/2007
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Last Update Date | 08/19/2007
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Provider Practice Location Address
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Address Line | 211 N SAGINAW RD
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City | MIDLAND
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State | MI
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Zip | 48640-3350
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Country | US
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Telephone | 989-835-1174
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Fax | 989-835-9351
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Provider Business Mailing Address
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Address Line | 211 N SAGINAW RD
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City | MIDLAND
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State | MI
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Zip | 48640-3350
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Country | US
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Telephone | 989-835-1174
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Fax | 989-835-9351
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301006906
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License Number State | MI
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