Provider Demographics
NPI:1033464169
Name:CAHILL, TRACI ROSE (PCC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:ROSE
Last Name:CAHILL
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3748 KILMUIR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-5606
Mailing Address - Country:US
Mailing Address - Phone:614-406-0299
Mailing Address - Fax:866-594-7023
Practice Address - Street 1:5701 N HIGH ST STE 308
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3960
Practice Address - Country:US
Practice Address - Phone:614-406-0299
Practice Address - Fax:866-594-7023
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-15
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE. 1100011101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0208112Medicaid