Provider Demographics
NPI:1275399180
Name:DUBOIS, TRACY ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:DUBOIS
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 1:3408 GRAVES LN
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-9220
Mailing Address - Country:US
Mailing Address - Phone:585-808-4575
Mailing Address - Fax:
Practice Address - Street 1:3408 GRAVES LN
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-9220
Practice Address - Country:US
Practice Address - Phone:585-808-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY014398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health