Basic Information
| Provider Information | |||||||||
| NPI: | 1568828820 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOWLAND | ||||||||
| FirstName: | TRACEY | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 80933 | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145808260 | ||||||||
| FaxNumber: | 8142869120 | ||||||||
| Practice Location | |||||||||
| Address1: | 1406 HAYS ST | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323012833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505210242 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/01/2016 | ||||||||
| LastUpdateDate: | 12/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | FL | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | 125001 | AK | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.