Provider Demographics
NPI:1528251097
Name:ALLAN, TRACEY M (PHD)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:M
Last Name:ALLAN
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 1:211 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-3350
Mailing Address - Country:US
Mailing Address - Phone:989-835-1174
Mailing Address - Fax:989-835-9351
Practice Address - Street 1:211 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-3350
Practice Address - Country:US
Practice Address - Phone:989-835-1174
Practice Address - Fax:989-835-9351
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006906103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical