Individual
TRACI J OTTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
7474 SOUTH CAMINO DE OESTE, TUCSON, AZ 85757
(520) 879-6077
Mailing address
7474 SOUTH CAMINO DE OESTE, TUCSON, AZ 85757
(520) 879-6077
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
905
NE
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-15036
AZ
101YM0800X
Mental Health Counselor
3011
NE
101YM0800X
Mental Health Counselor
436
NE
101YM0800X
Mental Health Counselor
Primary
LPC-15542
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025378400
—
NE
01
—
250405
MIDLANDS CHOICE PIN
NE
05
—
743005000
—
NE
01
—
85632
BCBS PIN
NE
Enumeration date
10/13/2006
Last updated
12/16/2015
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