Provider Demographics
NPI:1891865598
Name:PRITCHARD, TRACY ALLAN (LISW)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:ALLAN
Last Name:PRITCHARD
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-0401
Mailing Address - Country:US
Mailing Address - Phone:740-310-2961
Mailing Address - Fax:
Practice Address - Street 1:155 NEWELL AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1233
Practice Address - Country:US
Practice Address - Phone:740-310-2961
Practice Address - Fax:740-310-2961
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI56821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000362051OtherMEDICAL MUTUAL
OHY144529OtherMAGELLAN
OH000000362051OtherMEDICAL MUTUAL