Provider Demographics
NPI:1013946581
Name:DUNLAP, TRACY (LSCSW)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15812 E 77TH PL
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64139-1296
Mailing Address - Country:US
Mailing Address - Phone:816-591-6266
Mailing Address - Fax:816-817-3479
Practice Address - Street 1:6220 BLUE RIDGE CUT OFF STE 312
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-3730
Practice Address - Country:US
Practice Address - Phone:816-591-6266
Practice Address - Fax:816-313-0764
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030284641041C0700X
NE3242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS32886013OtherBCBS OF KC
KS100098010Medicaid