Healthcare Provider Details

I. General information

NPI: 1255157160
Provider Name (Legal Business Name): TRACY KAY LEMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 13TH AVE E
WEST FARGO ND
58078-3468
US

IV. Provider business mailing address

1401 13TH AVE E
WEST FARGO ND
58078-3468
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-0060
  • Fax: 701-364-0065
Mailing address:
  • Phone: 701-364-0060
  • Fax: 701-364-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC04927
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13138123657
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: