Provider Demographics
NPI:1720271497
Name:TRACY, KERRI LEANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:LEANNE
Last Name:TRACY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 CORINTH RD
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7603
Mailing Address - Country:US
Mailing Address - Phone:760-760-9636
Mailing Address - Fax:
Practice Address - Street 1:6201 CORINTH RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7603
Practice Address - Country:US
Practice Address - Phone:760-760-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW6285071041C0700X
CALCS 236811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical