Provider Demographics
NPI:1578792826
Name:TRACY ECKERT LLC
Entity Type:Organization
Organization Name:TRACY ECKERT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:MILLS
Authorized Official - Last Name:ECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LADC
Authorized Official - Phone:860-965-7500
Mailing Address - Street 1:22 CAMILLE LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2040
Mailing Address - Country:US
Mailing Address - Phone:860-965-7500
Mailing Address - Fax:410-861-6262
Practice Address - Street 1:50 ALBANY TPKE
Practice Address - Street 2:SUITE 5036
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2516
Practice Address - Country:US
Practice Address - Phone:860-965-7500
Practice Address - Fax:410-861-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty