Healthcare Provider Details

I. General information

NPI: 1871428979
Provider Name (Legal Business Name): ASHTYN ROSE TRACY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NW SAINT MARY DR STE 102
BLUE SPRINGS MO
64014-2539
US

IV. Provider business mailing address

801 NW SAINT MARY DR STE 102
BLUE SPRINGS MO
64014-2539
US

V. Phone/Fax

Practice location:
  • Phone: 816-719-0978
  • Fax:
Mailing address:
  • Phone: 816-719-0978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: