Provider Demographics
NPI:1821475443
Name:LAING, TRACY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:LAING
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8961 ASHTON LN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-6428
Mailing Address - Country:US
Mailing Address - Phone:269-377-9168
Mailing Address - Fax:
Practice Address - Street 1:136 E MAUMEE ST
Practice Address - Street 2:STE 8
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2765
Practice Address - Country:US
Practice Address - Phone:517-438-8144
Practice Address - Fax:517-438-8195
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010922101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional