Provider Demographics
NPI:1760616874
Name:SCOTT, TRACEY LYN (LBSW)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:LYN
Other - Last Name:RIVARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1495 E VERNE RD
Mailing Address - Street 2:
Mailing Address - City:BURT
Mailing Address - State:MI
Mailing Address - Zip Code:48417-9797
Mailing Address - Country:US
Mailing Address - Phone:810-257-3746
Mailing Address - Fax:810-257-3795
Practice Address - Street 1:420 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2445
Practice Address - Country:US
Practice Address - Phone:810-257-3746
Practice Address - Fax:810-257-3795
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802068415104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker