Provider Demographics
NPI:1003255696
Name:MCDONALD, TRACY M (LPCC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:M
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:M
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:177 LES GILREATH ROAD
Mailing Address - Street 2:
Mailing Address - City:STEARNS
Mailing Address - State:KY
Mailing Address - Zip Code:42647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90 MEDICAL LN
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-4216
Practice Address - Country:US
Practice Address - Phone:606-376-2466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY239923101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator