Provider Demographics
NPI:1013585884
Name:TRACY, SAMANTHA MCCABE (LPCI)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MCCABE
Last Name:TRACY
Suffix:
Gender:F
Credentials:LPCI
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:AYN
Other - Last Name:MCCABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4005 SE MALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3151
Mailing Address - Country:US
Mailing Address - Phone:971-570-3900
Mailing Address - Fax:
Practice Address - Street 1:8083 SE 13TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6668
Practice Address - Country:US
Practice Address - Phone:971-570-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional