Provider Demographics
NPI:1609166115
Name:KARVINEN, TRACY (MA, LPC, LCPC, CADC)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:KARVINEN
Suffix:
Gender:F
Credentials:MA, LPC, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 S STATE ROUTE 157
Mailing Address - Street 2:SUITE 200D
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1724
Mailing Address - Country:US
Mailing Address - Phone:618-659-5411
Mailing Address - Fax:618-659-5411
Practice Address - Street 1:2220 S STATE ROUTE 157
Practice Address - Street 2:SUITE 200D
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1724
Practice Address - Country:US
Practice Address - Phone:618-659-5411
Practice Address - Fax:618-659-5411
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19943101Y00000X
IL15725101YA0400X
IL178000692101YM0800X
IL180003528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health