Provider Demographics
NPI:1720009889
Name:BRACEY, NANCY JANE (LCPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JANE
Last Name:BRACEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-6724
Mailing Address - Country:US
Mailing Address - Phone:618-343-6230
Mailing Address - Fax:618-343-6235
Practice Address - Street 1:6201 W MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-6870
Practice Address - Country:US
Practice Address - Phone:618-343-6230
Practice Address - Fax:618-343-6235
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health