Healthcare Provider Details

I. General information

NPI: 1609567635
Provider Name (Legal Business Name): TRACY CROSS LPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/21/2023
Certification Date: 05/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 CAUGHEY RD STE 200
ERIE PA
16506-4098
US

IV. Provider business mailing address

3910 CAUGHEY RD STE 200
ERIE PA
16506-4098
US

V. Phone/Fax

Practice location:
  • Phone: 814-480-9227
  • Fax: 814-616-7439
Mailing address:
  • Phone: 814-480-9227
  • Fax: 814-616-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRACY CROSS
Title or Position: OWNER
Credential: LPC
Phone: 814-480-9227