Provider Demographics
NPI:1578570388
Name:TRACY, DELLA (PLSW)
Entity Type:Individual
Prefix:MS
First Name:DELLA
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:PLSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-1417
Mailing Address - Country:US
Mailing Address - Phone:660-425-4432
Mailing Address - Fax:660-425-4486
Practice Address - Street 1:2610 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-1417
Practice Address - Country:US
Practice Address - Phone:660-425-4432
Practice Address - Fax:660-425-4486
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060189551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical