Healthcare Provider Details

I. General information

NPI: 1295745669
Provider Name (Legal Business Name): SCOTT LEE TRACY PH.D, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 UNIVERSITY DR
LEMONT FURNACE PA
15456-1029
US

IV. Provider business mailing address

234 RANKIN RD
BELLE VERNON PA
15012-4817
US

V. Phone/Fax

Practice location:
  • Phone: 724-626-4444
  • Fax:
Mailing address:
  • Phone: 724-323-6008
  • Fax: 724-626-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC003297
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: