Provider Demographics
NPI:1962531335
Name:TOROSIAN, TRACEY (PHD)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:
Last Name:TOROSIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:TOROSIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, PLLC
Mailing Address - Street 1:20816 E 11 MILE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1565
Mailing Address - Country:US
Mailing Address - Phone:586-774-7344
Mailing Address - Fax:586-774-7345
Practice Address - Street 1:20816 E 11 MILE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1565
Practice Address - Country:US
Practice Address - Phone:586-774-7344
Practice Address - Fax:586-774-7345
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009014103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI320026000OtherPHCS
MI320026000OtherTRICARE
MI320026000OtherBEECH STREET CAPP CARE
MI68OEO46090OtherBLUE CROSS BLUE SHIELD
MI320026000OtherTRICARE