Provider Demographics
NPI:1073622270
Name:TRACY, MARGARET MICHELLE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:MICHELLE
Last Name:TRACY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-0184
Mailing Address - Country:US
Mailing Address - Phone:518-359-9379
Mailing Address - Fax:
Practice Address - Street 1:43 BROADWAY
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1718
Practice Address - Country:US
Practice Address - Phone:518-891-7083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health