Healthcare Provider Details

I. General information

NPI: 1811363021
Provider Name (Legal Business Name): TRACIE LYNN CARMICHAEL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N CHURCH ST
LAS CRUCES NM
88001-3440
US

IV. Provider business mailing address

530 N CHURCH ST
LAS CRUCES NM
88001-3440
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-9878
  • Fax:
Mailing address:
  • Phone: 575-526-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10868
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: