Provider Demographics
NPI:1417627852
Name:CORWIN, TRACY A (LADCP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:CORWIN
Suffix:
Gender:F
Credentials:LADCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BLUFFS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2465
Mailing Address - Country:US
Mailing Address - Phone:775-777-8477
Mailing Address - Fax:
Practice Address - Street 1:215 BLUFFS AVE STE 200
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2465
Practice Address - Country:US
Practice Address - Phone:775-777-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV06913-PC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)