Individual
TRACEY FREDERIKSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MC
Contact information
Practice address
2228 LAKEWOOD DR, PRESCOTT, AZ 86301-4476
(928) 583-2580
Mailing address
2228 LAKEWOOD DR, PRESCOTT, AZ 86301-4476
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-11878
AZ
Other
Enumeration date
08/13/2008
Last updated
08/13/2008
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