Provider Demographics
NPI:1235305749
Name:MCGEE, TRACY MAE (MA, LLP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MAE
Last Name:MCGEE
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 FULTON ST E
Mailing Address - Street 2:SUITE #126
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3200
Mailing Address - Country:US
Mailing Address - Phone:616-218-9903
Mailing Address - Fax:616-459-9059
Practice Address - Street 1:233 FULTON ST E
Practice Address - Street 2:SUITE #126
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3200
Practice Address - Country:US
Practice Address - Phone:616-218-9903
Practice Address - Fax:616-459-9059
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010517103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE