Healthcare Provider Details

I. General information

NPI: 1215373642
Provider Name (Legal Business Name): TRACI LEE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACI LEE DARGAN

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 MCKNIGHT RD N
NORTH ST PAUL MN
55109-2238
US

IV. Provider business mailing address

2365 MCKNIGHT RD N
NORTH ST PAUL MN
55109-2238
US

V. Phone/Fax

Practice location:
  • Phone: 651-760-3236
  • Fax:
Mailing address:
  • Phone: 651-760-3236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: