Provider Demographics
NPI:1104022029
Name:ANDERSON, TRACY L (LPC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1100 LUDINGTON ST STE 401
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3545
Mailing Address - Country:US
Mailing Address - Phone:906-789-1596
Mailing Address - Fax:906-789-2024
Practice Address - Street 1:1100 LUDINGTON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3542
Practice Address - Country:US
Practice Address - Phone:906-789-1596
Practice Address - Fax:906-789-2024
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010067101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical