Provider Demographics
NPI:1194277202
Name:SCHRUNK, TRACY (LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SCHRUNK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W LEROUX ST UNIT H8
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4265
Mailing Address - Country:US
Mailing Address - Phone:801-376-6298
Mailing Address - Fax:
Practice Address - Street 1:1277 N RHINESTONE DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-6802
Practice Address - Country:US
Practice Address - Phone:801-376-6298
Practice Address - Fax:186-643-1878
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-16391101Y00000X
UT294678-3501101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor