Healthcare Provider Details

I. General information

NPI: 1033133392
Provider Name (Legal Business Name): TRACY LYNNE THOMPSON-TORMASCHY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 SIMS ST STE 3
DICKINSON ND
58601-6561
US

IV. Provider business mailing address

9980 28TH ST SW
GLADSTONE ND
58630-9354
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-2955
  • Fax: 701-483-5322
Mailing address:
  • Phone: 701-227-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number363-11-1-96-120
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: