Provider Demographics
NPI:1497113831
Name:HATCH, TRACI LYN
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:LYN
Last Name:HATCH
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 1:6903 S STARFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5228
Mailing Address - Country:US
Mailing Address - Phone:801-550-3665
Mailing Address - Fax:
Practice Address - Street 1:11576 S STATE ST
Practice Address - Street 2:1001
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-6431
Practice Address - Country:US
Practice Address - Phone:801-550-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-30
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT96612116009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health