Provider Demographics
NPI:1699138800
Name:CHRIST, TRACY (MA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CHRIST
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:7100 SW HAMPTON ST
Mailing Address - Street 2:SUITE 128
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8315
Mailing Address - Country:US
Mailing Address - Phone:503-342-2510
Mailing Address - Fax:
Practice Address - Street 1:7100 SW HAMPTON ST
Practice Address - Street 2:SUITE 128
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8315
Practice Address - Country:US
Practice Address - Phone:503-342-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010136101YM0800X
ORC4170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health