Provider Demographics
NPI:1427499623
Name:COPP, TRACY JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:JANE
Last Name:COPP
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 1:1800 MORMON MILL RD
Mailing Address - Street 2:#A6
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-4175
Mailing Address - Country:US
Mailing Address - Phone:830-693-5645
Mailing Address - Fax:830-693-5644
Practice Address - Street 1:1800 MORMON MILL RD
Practice Address - Street 2:#A6
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4175
Practice Address - Country:US
Practice Address - Phone:830-693-5645
Practice Address - Fax:830-693-5644
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUCP-40103TC0700X
TX36387103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical