Provider Demographics
NPI:1396108163
Name:TRACY, DENAE
Entity type:Individual
Prefix:
First Name:DENAE
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MI
Mailing Address - Zip Code:49274-9779
Mailing Address - Country:US
Mailing Address - Phone:517-215-1713
Mailing Address - Fax:
Practice Address - Street 1:25 CARE DR
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-5054
Practice Address - Country:US
Practice Address - Phone:517-439-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020882211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical