Provider Demographics
NPI:1780957498
Name:RICHARDS, TRACY E (MS, LCMHC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:E
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SCALE AVENUE
Mailing Address - Street 2:BUILDING 18, SUITE 117
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4460
Mailing Address - Country:US
Mailing Address - Phone:802-773-2498
Mailing Address - Fax:802-773-2496
Practice Address - Street 1:1 SCALE AVENUE
Practice Address - Street 2:BUILDING 18, SUITE 117
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4460
Practice Address - Country:US
Practice Address - Phone:802-773-2498
Practice Address - Fax:802-773-2496
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0055057101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health