Provider Demographics
NPI:1811533177
Name:PALECEK, TRACY (NCC, LPC, QMHP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:PALECEK
Suffix:
Gender:F
Credentials:NCC, LPC, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 JACKSON BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3452
Mailing Address - Country:US
Mailing Address - Phone:605-222-4398
Mailing Address - Fax:605-791-0122
Practice Address - Street 1:2218 JACKSON BLVD STE 13
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3452
Practice Address - Country:US
Practice Address - Phone:605-222-4398
Practice Address - Fax:605-791-0122
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7405101YM0800X
SDLPC-MH30602101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health