Provider Demographics
NPI:1083143291
Name:GUSMAN, TRACEY M (LPC, SAC,NCC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:M
Last Name:GUSMAN
Suffix:
Gender:F
Credentials:LPC, SAC,NCC
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:M
Other - Last Name:SPATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6304 KELLY PL
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-4397
Mailing Address - Country:US
Mailing Address - Phone:715-574-5577
Mailing Address - Fax:715-679-3080
Practice Address - Street 1:6304 KELLY PL
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-4397
Practice Address - Country:US
Practice Address - Phone:715-574-5577
Practice Address - Fax:715-679-3080
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
WI7316101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health