Provider Demographics
NPI:1124164827
Name:PRICE, TRACY JOHN (PSYD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:JOHN
Last Name:PRICE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:T
Other - Middle Name:J
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:9250 W. 5TH AVE.
Mailing Address - Street 2:302
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-7400
Mailing Address - Country:US
Mailing Address - Phone:303-202-6143
Mailing Address - Fax:720-294-0405
Practice Address - Street 1:9250 W 5TH AVE
Practice Address - Street 2:302
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1098
Practice Address - Country:US
Practice Address - Phone:303-202-6143
Practice Address - Fax:720-294-0405
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1933103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1933OtherPSYCHOLOGIST LICENSE