Provider Demographics
NPI:1710434170
Name:TRACY GEORGE LLC
Entity Type:Organization
Organization Name:TRACY GEORGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:603-343-6352
Mailing Address - Street 1:41 TOPAZ PL
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3583
Mailing Address - Country:US
Mailing Address - Phone:603-343-6352
Mailing Address - Fax:207-221-1219
Practice Address - Street 1:45 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3217
Practice Address - Country:US
Practice Address - Phone:603-343-6352
Practice Address - Fax:207-221-1219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC15680251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health