Provider Demographics
NPI:1801360250
Name:WESTPHAL, TRACI (LPC)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:WESTPHAL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4191 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2026
Mailing Address - Country:US
Mailing Address - Phone:810-358-4460
Mailing Address - Fax:
Practice Address - Street 1:1121 VILLA LINDE CT
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3410
Practice Address - Country:US
Practice Address - Phone:810-515-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015259101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401015259OtherLICENSE PROFESSIONAL COUNSELOR