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General NPI Number Information
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NPI Number | 1710527718
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Entity Type | Individual
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Provider Name | TRACY ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 7000 W PALMETTO PARK RD STE 407
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City | BOCA RATON
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State | FL
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Zip | 33433-3425
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Country | US
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Telephone | 812-486-9019
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Fax |
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Provider Business Mailing Address
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Address Line | 3835 N FREEWAY BLVD STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95834-1954
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Country | US
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Telephone | 812-486-9019
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39003441A
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License Number State | IN
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