Basic Information
| Provider Information | |||||||||
| NPI: | 1780753913 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRACY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | OZOLS | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 OAK PLZ STE 208 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288013000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285759760 | ||||||||
| FaxNumber: | 8285759761 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 OAK PLZ | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288013008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282522501 | ||||||||
| FaxNumber: | 8282522701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 2452 | NC | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 6000038 | 05 | NC | MEDICAID | 129XM | 01 | NC | BCBS | OTHER |