Individual
JESSICA TRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
21448 N 75TH AVE STE 6, GLENDALE, AZ 85308-5978
(940) 631-2629
Mailing address
13421 N 43RD AVE APT 3095, PHOENIX, AZ 85029-1042
(940) 631-2629
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
18662
AZ
Other
Enumeration date
01/06/2020
Last updated
01/06/2020
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