MEDICARE: TRACE JORY LOPTIEN M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1255716106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACE JORY LOPTIEN M.S.

Provider Business Mailing Address
First Line	:	115 MIDDLETON ST.
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210
Country	:	US
Telephone Number	:	815-739-8034
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 MIDDLETON ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-2233
Country	:	US
Telephone Number	:	815-739-8034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	11/03/2016

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