Healthcare Provider Details

I. General information

NPI: 1669729919
Provider Name (Legal Business Name): TRACY LEE ADAMS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17571 N DAM ACCESS RD
WARSAW MO
65355-6396
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 660-428-1280
  • Fax:
Mailing address:
  • Phone: 660-885-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2012024653
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: