Provider Demographics
NPI:1083596191
Name:CLARKSON, TRACY DIANN
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:DIANN
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 MEDICAL PARK DR STE 400
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5641
Mailing Address - Country:US
Mailing Address - Phone:865-970-9800
Mailing Address - Fax:
Practice Address - Street 1:423 MEDICAL PARK DR STE 400
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5641
Practice Address - Country:US
Practice Address - Phone:865-970-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health