Provider Demographics
NPI:1902275704
Name:SELLS, TRACY HOWARD (BS NEUROSCIENCE)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:HOWARD
Last Name:SELLS
Suffix:
Gender:M
Credentials:BS NEUROSCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 S VIRGINIA ST
Mailing Address - Street 2:91
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2413
Mailing Address - Country:US
Mailing Address - Phone:775-412-5769
Mailing Address - Fax:
Practice Address - Street 1:805 S VIRGINIA ST
Practice Address - Street 2:91
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2413
Practice Address - Country:US
Practice Address - Phone:775-412-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling