Provider Demographics
NPI:1598281867
Name:PITTMAN, TRACY LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15502 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-5520
Mailing Address - Country:US
Mailing Address - Phone:734-265-0330
Mailing Address - Fax:
Practice Address - Street 1:15502 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-5520
Practice Address - Country:US
Practice Address - Phone:734-265-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health