Provider Demographics
NPI:1477823011
Name:FRITSCH, TRACI LYNN (EDD, NCSP, LPC)
Entity Type:Individual
Prefix:DR
First Name:TRACI
Middle Name:LYNN
Last Name:FRITSCH
Suffix:
Gender:F
Credentials:EDD, NCSP, LPC
Other - Prefix:DR
Other - First Name:TRACI
Other - Middle Name:LYNN
Other - Last Name:FEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD, NCSP, LPC
Mailing Address - Street 1:88 W COMMERCE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-7994
Mailing Address - Country:US
Mailing Address - Phone:208-783-7687
Mailing Address - Fax:
Practice Address - Street 1:88 W COMMERCE DR
Practice Address - Street 2:SUITE C
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-7994
Practice Address - Country:US
Practice Address - Phone:208-762-4405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID103TS0200X
IDLPC-4041101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool