Provider Demographics
NPI:1194331215
Name:TRACIE A NICOLL PHD
Entity type:Organization
Organization Name:TRACIE A NICOLL PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NICOLL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-247-3561
Mailing Address - Street 1:245 E CHEYENNE MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3719
Mailing Address - Country:US
Mailing Address - Phone:719-232-5223
Mailing Address - Fax:719-362-4439
Practice Address - Street 1:245 E CHEYENNE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3719
Practice Address - Country:US
Practice Address - Phone:719-247-3561
Practice Address - Fax:719-362-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health