Healthcare Provider Details

I. General information

NPI: 1235305749
Provider Name (Legal Business Name): TRACY MAE MCGEE MA, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 FULTON ST E SUITE #126
GRAND RAPIDS MI
49503-3200
US

IV. Provider business mailing address

233 FULTON ST E SUITE #126
GRAND RAPIDS MI
49503-3200
US

V. Phone/Fax

Practice location:
  • Phone: 616-218-9903
  • Fax: 616-459-9059
Mailing address:
  • Phone: 616-218-9903
  • Fax: 616-459-9059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301010517
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: