Provider Demographics
NPI:1740410737
Name:MEADERS, TRACIE (LPC)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:MEADERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16941 N EAGLE RIVER LOOP RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7824
Mailing Address - Country:US
Mailing Address - Phone:907-726-3963
Mailing Address - Fax:
Practice Address - Street 1:8012 STEWART MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-9013
Practice Address - Country:US
Practice Address - Phone:907-279-9627
Practice Address - Fax:907-279-9632
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 106H00000X
AKPCOP907101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist