Provider Demographics
NPI:1578919676
Name:TRACY RELATIONAL INSTITUTE, LLC
Entity Type:Organization
Organization Name:TRACY RELATIONAL INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:712-310-7116
Mailing Address - Street 1:25 S 15TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3900
Mailing Address - Country:US
Mailing Address - Phone:712-310-7116
Mailing Address - Fax:
Practice Address - Street 1:25 S 15TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3900
Practice Address - Country:US
Practice Address - Phone:712-310-7116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty