Provider Demographics
NPI:1659670065
Name:SCHURCH, TRACY MICHELLE (LISW)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:MICHELLE
Last Name:SCHURCH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24500 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5601
Mailing Address - Country:US
Mailing Address - Phone:440-899-1300
Mailing Address - Fax:
Practice Address - Street 1:24500 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44145-5601
Practice Address - Country:US
Practice Address - Phone:440-899-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2014-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1001010-TRNE104100000X
OHS.1200598104100000X
OHI.14404491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker