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General NPI Number Information
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NPI Number | 1902942790
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Entity Type | Individual
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Provider Name | TRACY A TERRELL LPC
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 7000 W 120TH AVE SUITE D
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City | BROOMFIELD
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State | CO
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Zip | 80020-2821
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Country | US
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Telephone | 303-926-9191
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Fax | 303-926-9101
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Provider Business Mailing Address
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Address Line | 7000 W 120TH AVE SUITE D
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City | BROOMFIELD
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State | CO
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Zip | 80020-2821
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Country | US
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Telephone | 303-926-9191
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Fax | 303-926-9101
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2423
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC-0000301
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License Number State | DE
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