Provider Demographics
NPI:1831398783
Name:FRAY, TRACEY (LMSW, CSW)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:FRAY
Suffix:
Gender:F
Credentials:LMSW, CSW
Other - Prefix:MS
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:TURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2445 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-2604
Mailing Address - Country:US
Mailing Address - Phone:810-687-0050
Mailing Address - Fax:
Practice Address - Street 1:6379 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9566
Practice Address - Country:US
Practice Address - Phone:989-777-4357
Practice Address - Fax:989-777-7257
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801076909104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003845OtherMCLAREN HEALTH PLAN
MI0995824OtherHEALTH PLUS OF MI