Healthcare Provider Details

I. General information

NPI: 1437568326
Provider Name (Legal Business Name): TRACY D BURRIS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 LAUREL BOWIE RD UNIT 803
BOWIE MD
20718-7522
US

IV. Provider business mailing address

6710 LAUREL BOWIE RD UNIT 803
BOWIE MD
20718-7522
US

V. Phone/Fax

Practice location:
  • Phone: 240-366-4260
  • Fax: 301-576-7487
Mailing address:
  • Phone: 240-336-4260
  • Fax: 301-576-7487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP5664
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC7042
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: