Provider Demographics
NPI:1770253163
Name:TRACEY, TYLER (QMHS)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:TRACEY
Suffix:
Gender:M
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 W CENTRAL AVE STE 366E
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1416
Mailing Address - Country:US
Mailing Address - Phone:419-531-2408
Mailing Address - Fax:419-531-2442
Practice Address - Street 1:3450 W CENTRAL AVE STE 366E
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1416
Practice Address - Country:US
Practice Address - Phone:419-531-2408
Practice Address - Fax:419-531-2442
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator