Provider Demographics
NPI:1275817801
Name:JONES, TRACY LYNNE
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LYNNE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:LYNNE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2033
Mailing Address - Country:US
Mailing Address - Phone:248-338-7458
Mailing Address - Fax:248-338-7513
Practice Address - Street 1:303 W WATER ST
Practice Address - Street 2:SUITE 108
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5627
Practice Address - Country:US
Practice Address - Phone:810-232-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker