Provider Demographics
NPI:1740918739
Name:HOLDER, TRACIE M (MA, PLPC, NCC)
Entity type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:M
Last Name:HOLDER
Suffix:
Gender:F
Credentials:MA, PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 SW BATTEN DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4746
Mailing Address - Country:US
Mailing Address - Phone:816-914-2387
Mailing Address - Fax:
Practice Address - Street 1:1320 NE WINDSOR DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-8477
Practice Address - Country:US
Practice Address - Phone:816-914-2387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021030529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional