Provider Demographics
NPI:1952033284
Name:LANDREY, TRACY LYNN (MA COUNSELING)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:LANDREY
Suffix:
Gender:F
Credentials:MA COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:EAST TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730-9325
Mailing Address - Country:US
Mailing Address - Phone:989-942-4714
Mailing Address - Fax:
Practice Address - Street 1:4093 M-65
Practice Address - Street 2:
Practice Address - City:HALE
Practice Address - State:MI
Practice Address - Zip Code:48739
Practice Address - Country:US
Practice Address - Phone:989-728-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health