Healthcare Provider Details

I. General information

NPI: 1518260314
Provider Name (Legal Business Name): TRACY ANN PARASKEVIN M.A., L.L.P.C., NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 HALL RD SUITE 303
UTICA MI
48317-5711
US

IV. Provider business mailing address

11228 ALGER ST
WARREN MI
48093-2529
US

V. Phone/Fax

Practice location:
  • Phone: 586-997-3153
  • Fax:
Mailing address:
  • Phone: 586-344-4575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012189
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: