Provider Demographics
NPI:1578628590
Name:TRACY, STEPHEN N (LMFT NCP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:N
Last Name:TRACY
Suffix:
Gender:M
Credentials:LMFT NCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7812 WATERFALLS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6707
Mailing Address - Country:US
Mailing Address - Phone:702-258-2648
Mailing Address - Fax:702-651-5843
Practice Address - Street 1:7812 WATERFALLS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-6707
Practice Address - Country:US
Practice Address - Phone:702-258-2648
Practice Address - Fax:702-651-5843
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV781106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist