Provider Demographics
NPI:1881849230
Name:TRACY, VICTORIA ANN (LIMHP, LADC)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ANN
Last Name:TRACY
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 S BURLINGTON AVE
Mailing Address - Street 2:# 107,
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-6960
Mailing Address - Country:US
Mailing Address - Phone:402-462-4200
Mailing Address - Fax:402-462-4201
Practice Address - Street 1:835 S BURLINGTON AVE
Practice Address - Street 2:# 107,
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6960
Practice Address - Country:US
Practice Address - Phone:402-462-4200
Practice Address - Fax:402-462-4201
Is Sole Proprietor?:No
Enumeration Date:2008-11-27
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE665101YA0400X
NE3379101YM0800X
NE918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025208600Medicaid
NE85114OtherBCBS
NE47052851507Medicaid