Provider Demographics
NPI:1235382441
Name:GRANT, TRACY ELIZABETH (LMHC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ELIZABETH
Last Name:GRANT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SUMMER ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3076
Mailing Address - Country:US
Mailing Address - Phone:978-856-4923
Mailing Address - Fax:
Practice Address - Street 1:7 SUMMER ST
Practice Address - Street 2:SUITE 19
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3076
Practice Address - Country:US
Practice Address - Phone:978-856-4923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health