Provider Demographics
NPI:1134856586
Name:LEXVOLD, TRACEY ANNE (LPCC)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANNE
Last Name:LEXVOLD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:ANNE
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:3203 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2406
Mailing Address - Country:US
Mailing Address - Phone:218-263-9237
Mailing Address - Fax:
Practice Address - Street 1:3203 3RD AVE W
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2406
Practice Address - Country:US
Practice Address - Phone:218-263-9237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health