Healthcare Provider Details

I. General information

NPI: 1912851999
Provider Name (Legal Business Name): TRACEY THOMAS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 03/01/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9033 GLADES RD STE D
BOCA RATON FL
33434-3939
US

IV. Provider business mailing address

29 TAM O SHANTER LN
BOCA RATON FL
33431-3904
US

V. Phone/Fax

Practice location:
  • Phone: 561-406-0636
  • Fax:
Mailing address:
  • Phone: 561-206-2823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27360
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: