Provider Demographics
NPI:1407057425
Name:BROCKMAN, TRACY F (LPC,MHSP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:F
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:LPC,MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 E LYTLE ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3812
Mailing Address - Country:US
Mailing Address - Phone:615-631-7322
Mailing Address - Fax:
Practice Address - Street 1:441 E LYTLE ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3812
Practice Address - Country:US
Practice Address - Phone:615-631-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health