Provider Demographics
NPI:1407186299
Name:HEART, TRACY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HEART
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5156 SW MULTNOMAH BLVD
Mailing Address - Street 2:CONDO F
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3372
Mailing Address - Country:US
Mailing Address - Phone:503-805-6185
Mailing Address - Fax:
Practice Address - Street 1:2037 NW LOVEJOY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1515
Practice Address - Country:US
Practice Address - Phone:503-805-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2403101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional