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General NPI Number Information
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NPI Number | 1821476573
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Entity Type | Individual
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Provider Name | TRACIE OTTMAN MA, LPCA
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Gender | Female
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 12/21/2022
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Provider Practice Location Address
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Address Line | 1121 HAMPSHIRE LN STE 100
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City | RICHARDSON
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State | TX
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Zip | 75080-4306
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Country | US
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Telephone | 469-367-6785
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Fax |
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Provider Business Mailing Address
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Address Line | 500 FAIRWAY DR STE 102
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-1814
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Country | US
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Telephone |
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 90507
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | A15044
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License Number State | NC
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