Provider Demographics
NPI:1205033982
Name:MURPHY, TRACY ELAINE
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ELAINE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:ELAINE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32860 KELLY RD
Mailing Address - Street 2:APARTMENT 203
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-1045
Mailing Address - Country:US
Mailing Address - Phone:586-354-4643
Mailing Address - Fax:
Practice Address - Street 1:35555 GARFIELD RD
Practice Address - Street 2:SUITE 3B
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-5517
Practice Address - Country:US
Practice Address - Phone:586-792-1654
Practice Address - Fax:586-792-1656
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803085423104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker