Provider Demographics
NPI:1043099575
Name:TRACE COUNSELING AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:TRACE COUNSELING AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:224-388-1867
Mailing Address - Street 1:3233 N ARLINGTON HEIGHTS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1579
Mailing Address - Country:US
Mailing Address - Phone:224-388-1867
Mailing Address - Fax:
Practice Address - Street 1:3233 N ARLINGTON HEIGHTS RD STE 203
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1579
Practice Address - Country:US
Practice Address - Phone:224-388-1867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty