Provider Demographics
NPI:1255522272
Name:HORTMAN, TRACY LYNN (CMSW,LMHP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:HORTMAN
Suffix:
Gender:F
Credentials:CMSW,LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20230 WIRT ST APT 205
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2787
Mailing Address - Country:US
Mailing Address - Phone:402-916-0055
Mailing Address - Fax:
Practice Address - Street 1:17500 BURKE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2244
Practice Address - Country:US
Practice Address - Phone:402-401-3743
Practice Address - Fax:402-401-3751
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4073101YM0800X
NE14471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health