Individual
DR. TRACIE MERTZ MCCONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
651 S MAIN ST, GREENVILLE, SC 29601-2504
(864) 241-2600
(864) 454-1130
Mailing address
300 E MCBEE AVE, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
686
SC
103T00000X
Psychologist
Primary
686
SC
103TA0700X
Adult Development & Aging Psychologist
686
SC
103TB0200X
Cognitive & Behavioral Psychologist
686
SC
103TC0700X
Clinical Psychologist
686
SC
103TH0100X
Health Service Psychologist
686
SC
103TP2701X
Group Psychotherapy Psychologist
686
SC
103TR0400X
Rehabilitation Psychologist
686
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680016185
MEDICARE RAILROAD
SC
05
—
PS0262
—
SC
Enumeration date
01/17/2007
Last updated
07/08/2021
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