Provider Demographics
NPI:1710395439
Name:SALAZAR, TRACY (LLPC, CADC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:LLPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 RIVERSIDE AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1465
Mailing Address - Country:US
Mailing Address - Phone:517-264-2244
Mailing Address - Fax:517-263-3325
Practice Address - Street 1:770 RIVERSIDE AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1445
Practice Address - Country:US
Practice Address - Phone:517-264-2244
Practice Address - Fax:517-263-3325
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011933101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)