Provider Demographics
NPI:1760984660
Name:TURPIN-MOGELNICKI, TRACY LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:TURPIN-MOGELNICKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:MOGELNICKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:6147 ISLAND LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9527
Mailing Address - Country:US
Mailing Address - Phone:248-219-0937
Mailing Address - Fax:
Practice Address - Street 1:10524 GRAND RIVER RD STE 107C
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9559
Practice Address - Country:US
Practice Address - Phone:248-219-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801071130104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker