Provider Demographics
NPI:1033133392
Name:THOMPSON-TORMASCHY, TRACY LYNNE (LPCC)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LYNNE
Last Name:THOMPSON-TORMASCHY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9980 28TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:ND
Mailing Address - Zip Code:58630-9354
Mailing Address - Country:US
Mailing Address - Phone:701-227-1062
Mailing Address - Fax:
Practice Address - Street 1:2125 SIMS ST STE 3
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-6561
Practice Address - Country:US
Practice Address - Phone:701-483-2955
Practice Address - Fax:701-483-5322
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND363-11-1-96-120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND26790Medicare UPIN