Provider Demographics
NPI:1275054553
Name:GROTHE, TRACY LYNN (LIMHP, LPC)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LYNN
Last Name:GROTHE
Suffix:
Gender:F
Credentials:LIMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16619 BANCROFT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-1823
Mailing Address - Country:US
Mailing Address - Phone:402-960-5038
Mailing Address - Fax:
Practice Address - Street 1:17940 WELCH PLZ STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3714
Practice Address - Country:US
Practice Address - Phone:402-960-5038
Practice Address - Fax:402-891-5081
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health