Provider Demographics
NPI:1922357672
Name:CORLE, TRACIE J (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:J
Last Name:CORLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:TRACIE
Other - Middle Name:JEANNE
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:834 FALLS AVE STE 1050
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3363
Mailing Address - Country:US
Mailing Address - Phone:208-736-0995
Mailing Address - Fax:208-736-0999
Practice Address - Street 1:834 FALLS AVE STE 1050
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3363
Practice Address - Country:US
Practice Address - Phone:208-736-0995
Practice Address - Fax:208-736-0999
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional