Provider Demographics
NPI:1184184202
Name:SCHUH, TRACY DAWN (LCDCIII)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:DAWN
Last Name:SCHUH
Suffix:
Gender:F
Credentials:LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 COUNTY ROAD 182
Mailing Address - Street 2:
Mailing Address - City:KITTS HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45645-8755
Mailing Address - Country:US
Mailing Address - Phone:740-646-0042
Mailing Address - Fax:
Practice Address - Street 1:300 MORTON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1028
Practice Address - Country:US
Practice Address - Phone:740-628-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-24
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)