Provider Demographics
NPI:1184348195
Name:BIGELOW, TRACI CHRISTINE (LMHCA)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:CHRISTINE
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2119
Mailing Address - Country:US
Mailing Address - Phone:503-505-3851
Mailing Address - Fax:
Practice Address - Street 1:7600 NE 41ST ST STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6772
Practice Address - Country:US
Practice Address - Phone:503-505-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61357896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health