Provider Demographics
NPI:1215079975
Name:LAWRENCE, TRACY TODD (PHD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:TODD
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 E 690 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-6682
Mailing Address - Country:US
Mailing Address - Phone:801-802-9558
Mailing Address - Fax:801-765-4357
Practice Address - Street 1:1054 E 690 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-6682
Practice Address - Country:US
Practice Address - Phone:801-802-9558
Practice Address - Fax:801-765-4357
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT273951-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist