Healthcare Provider Details

I. General information

NPI: 1407062367
Provider Name (Legal Business Name): TRACY STEPHEN COMEAU LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 01/22/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1273 MAINE ST
POLAND ME
04274-7328
US

IV. Provider business mailing address

P.O. BOX 201
POLAND ME
04274-0201
US

V. Phone/Fax

Practice location:
  • Phone: 207-754-2233
  • Fax:
Mailing address:
  • Phone: 207-754-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC3089
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: