MEDICARE: AMANDA TRACEY LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LC17376	MD

General Provider Information

NPI Number	:	1982471611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA TRACEY LCPC

Provider Business Mailing Address
First Line	:	211 CRESTVIEW DR
Second Line	:
City	:	THURMONT
State	:	MD
Zip	:	21788-1806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 SOLAREX CT UNIT 201
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-8655
Country	:	US
Telephone Number	:	301-663-8263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	01/09/2026

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