Provider Demographics
NPI:1851414445
Name:WYMAN, TRACY LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:WYMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W TAMI CIR
Mailing Address - Street 2:A306
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-9096
Mailing Address - Country:US
Mailing Address - Phone:734-674-1563
Mailing Address - Fax:
Practice Address - Street 1:120 W TAMI CIR
Practice Address - Street 2:A306
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-9096
Practice Address - Country:US
Practice Address - Phone:734-674-1563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010811341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical