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NPI Code Detail

MEDICARE: TRACY TEIMOURIAN

MEDICARE: TRACY TEIMOURIAN
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
11041C0700XClinical Social Worker105607TX

General Provider Information

NPI Number : 1639419351
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY TEIMOURIAN
Provider Business Mailing Address
First Line : 2030 E JACKSON RD UNIT 113312
Second Line :
City : CARROLLTON
State : TX
Zip : 75011-4457
Country : US
Telephone Number : 469-554-9992
Fax Number :
Provider Business Practice Location Address
First Line : 4222 TRINITY MILLS RD STE 250
Second Line :
City : DALLAS
State : TX
Zip : 75287-7655
Country : US
Telephone Number : 972-534-4288
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2013
Last Update Date : 08/21/2023

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Directions to “ TRACY TEIMOURIAN ” Practice Location

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