Active NPI
Jessica Tracy, LAC
- Professional Counselor
- Glendale, AZ
National Provider Identifier
1154960250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 18662
- Practice address
- 21448 N 75TH Ave Ste 6
Glendale, AZ 85308-5978 - Phone
- (940) 631-2629
- NPI assigned
- Jan 6, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 18662 | AZ | Primary |
Addresses
Primary practice location
21448 N 75TH Ave Ste 6
Glendale, AZ 85308-5978
Mailing address
13421 N 43Rd Ave Apt 3095
Phoenix, AZ 85029-1042
Phone (940) 631-2629
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18662 | AZ | MD | Occupational Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578268800000",
"number": "1154960250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13421 N 43RD AVE APT 3095",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850291042",
"telephone_number": "940-631-2629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21448 N 75TH AVE STE 6",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853085978",
"telephone_number": "940-631-2629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACY",
"first_name": "JESSICA",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-06",
"last_updated": "2020-01-06",
"certification_date": "2020-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AZ",
"license": "18662",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.