Provider Demographics
NPI:1982996690
Name:BASILE, TRACY M (PHD)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:M
Last Name:BASILE
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 1:6655 W SAHARA AVE STE B200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-2832
Mailing Address - Country:US
Mailing Address - Phone:702-248-8866
Mailing Address - Fax:702-248-1339
Practice Address - Street 1:2740 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5306
Practice Address - Country:US
Practice Address - Phone:702-248-8866
Practice Address - Fax:702-248-1339
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA107103TC0700X
225400000X, 225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor