Provider Demographics
NPI:1184097834
Name:BOYLE, TRACEY (LPC)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:BOYLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10664 CENTER HWY STE B
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2017
Mailing Address - Country:US
Mailing Address - Phone:724-875-9153
Mailing Address - Fax:
Practice Address - Street 1:10664 CENTER HWY STE B
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-2017
Practice Address - Country:US
Practice Address - Phone:724-875-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008398101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional