Provider Demographics
NPI:1689428583
Name:EASON, TRACEY P (LMSW)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:P
Last Name:EASON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90574
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99509-0574
Mailing Address - Country:US
Mailing Address - Phone:907-795-8960
Mailing Address - Fax:
Practice Address - Street 1:205 E BENSON BLVD STE 504
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4019
Practice Address - Country:US
Practice Address - Phone:907-795-8960
Practice Address - Fax:800-511-7484
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK198944104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker