Provider Demographics
NPI:1760641641
Name:SNOW, TRACEY KIM (LCPC)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:KIM
Last Name:SNOW
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 1:13728 W CAREFREE DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8655
Mailing Address - Country:US
Mailing Address - Phone:708-837-3722
Mailing Address - Fax:708-966-4244
Practice Address - Street 1:14933 S FOUNDERS XING
Practice Address - Street 2:OPTIONAL
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-6049
Practice Address - Country:US
Practice Address - Phone:708-837-3722
Practice Address - Fax:708-966-4244
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178001521101YM0800X
IL180006920101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty