Healthcare Provider Details

I. General information

NPI: 1700498805
Provider Name (Legal Business Name): TRACY BAILEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 W 11TH AVE
MITCHELL SD
57301-1310
US

IV. Provider business mailing address

318 W 11TH AVE
MITCHELL SD
57301-1310
US

V. Phone/Fax

Practice location:
  • Phone: 605-630-8404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20576
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: