Provider Demographics
NPI:1598168791
Name:BELL, TRACY LYNN (LAC)
Entity Type:Individual
Prefix:MISS
First Name:TRACY
Middle Name:LYNN
Last Name:BELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 15TH ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4220
Mailing Address - Country:US
Mailing Address - Phone:701-373-8301
Mailing Address - Fax:701-373-8356
Practice Address - Street 1:123 15TH ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4220
Practice Address - Country:US
Practice Address - Phone:701-373-8301
Practice Address - Fax:701-373-8356
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1674101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)