Provider Demographics
NPI:1528364163
Name:BIRKINBINE, TRACY (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BIRKINBINE
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 MANCHESTER RD
Mailing Address - Street 2:SUITE 182
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4423
Mailing Address - Country:US
Mailing Address - Phone:314-514-5852
Mailing Address - Fax:
Practice Address - Street 1:12015 MANCHESTER RD
Practice Address - Street 2:SUITE 182
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-4423
Practice Address - Country:US
Practice Address - Phone:314-514-5852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-30
Last Update Date:2011-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010003299101YP2500X
IL180.007641101YP2500X
IL178.004705101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional