Individual
DR. TRACY BLACK CECCHINI III
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
VA SLC HEALTHCARE SYSTEM, 500 FOOTHILL DR., SALT LAKE CITY, UT 84148-0001
(801) 582-1565
(801) 584-5680
Mailing address
9227 STONE VIEW CV, SANDY, UT 84093-3204
(801) 983-2708
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
013988-1
NY
103TC0700X
Clinical Psychologist
Primary
5848945-2501
UT
Other
Enumeration date
06/13/2006
Last updated
07/08/2007
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