Healthcare Provider Details

I. General information

NPI: 1619834538
Provider Name (Legal Business Name): TRACY LEWIS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 NW 63RD TER
MARGATE FL
33063-5620
US

IV. Provider business mailing address

2913 NW 63RD TER
MARGATE FL
33063-5620
US

V. Phone/Fax

Practice location:
  • Phone: 954-302-7621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: