Provider Demographics
NPI:1386114262
Name:PARNELL, TRACIE G
Entity type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:G
Last Name:PARNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9648 OLIVE BLVD STE 438
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3002
Mailing Address - Country:US
Mailing Address - Phone:314-265-5974
Mailing Address - Fax:844-519-7811
Practice Address - Street 1:4000 ENGLER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-4125
Practice Address - Country:US
Practice Address - Phone:314-252-8216
Practice Address - Fax:844-519-7811
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health