Provider Demographics
NPI:1790574549
Name:DORSETT, TRACY LYNN
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:DORSETT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-0637
Mailing Address - Country:US
Mailing Address - Phone:812-254-1530
Mailing Address - Fax:812-254-1636
Practice Address - Street 1:101 COSTELLO DR
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-1433
Practice Address - Country:US
Practice Address - Phone:812-295-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1110229103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool