Basic Information
Provider Information
NPI: 1831574896
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STUART
FirstName: TRACY
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 155 INVERNESS DR W
Address2: SUITE 200
City: ENGLEWOOD
State: CO
PostalCode: 801125095
CountryCode: US
TelephoneNumber: 3037939634
FaxNumber: 3038890838
Practice Location
Address1: 5500 S SYCAMORE ST
Address2:  
City: LITTLETON
State: CO
PostalCode: 801208201
CountryCode: US
TelephoneNumber: 3037979440
FaxNumber: 3037979354
Other Information
ProviderEnumerationDate: 07/20/2015
LastUpdateDate: 07/20/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XLPC.0012188COY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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