Provider Demographics
NPI:1972830826
Name:GOGAN, TRACY L (LMSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:L
Last Name:GOGAN
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:SARACINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, ACSW
Mailing Address - Street 1:497 E COLUMBIA AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5463
Mailing Address - Country:US
Mailing Address - Phone:269-963-7135
Mailing Address - Fax:269-963-0071
Practice Address - Street 1:497 E COLUMBIA AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5463
Practice Address - Country:US
Practice Address - Phone:269-963-7135
Practice Address - Fax:269-963-0071
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010910161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical