Provider Demographics
NPI:1528367075
Name:MINTO, TRACEY (LIMHP, LIMFT)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:MINTO
Suffix:
Gender:F
Credentials:LIMHP, LIMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17940 WELCH PLZ STE 106
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3714
Mailing Address - Country:US
Mailing Address - Phone:402-630-2939
Mailing Address - Fax:402-891-5081
Practice Address - Street 1:17940 WELCH PLZ STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3714
Practice Address - Country:US
Practice Address - Phone:402-630-2939
Practice Address - Fax:402-891-5081
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1421, 174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE9221Medicaid