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Individual

TRACEE DURHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
151 N MAIN ST, DECATUR, IL 62523-1206
(217) 420-4776
(217) 362-9007
Mailing address
151 N MAIN ST, DECATUR, IL 62523-1206
(217) 420-4776
(217) 362-9007

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
150-104984
IL

Other

Enumeration date
04/08/2021
Last updated
04/08/2021
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