Basic Information
| Provider Information | |||||||||
| NPI: | 1780267286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TORMES | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6901 SHAWNEE MISSION PKWY | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662024005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889131910 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6901 SHAWNEE MISSION PKWY | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662024005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889131910 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2021 | ||||||||
| LastUpdateDate: | 05/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 2021015486 | MO | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.