Provider Demographics
NPI:1407062367
Name:COMEAU, TRACY STEPHEN (LCPC)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:STEPHEN
Last Name:COMEAU
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HICKS RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4314
Mailing Address - Country:US
Mailing Address - Phone:207-512-2632
Mailing Address - Fax:
Practice Address - Street 1:78 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1221
Practice Address - Country:US
Practice Address - Phone:207-858-4860
Practice Address - Fax:207-858-4864
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional