Healthcare Provider Details

I. General information

NPI: 1982798666
Provider Name (Legal Business Name): TRACEY HUNTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 HARRAH DR STE I
SPRING HILL TN
37174-6255
US

IV. Provider business mailing address

PO BOX 215
THOMPSONS STATION TN
37179-0215
US

V. Phone/Fax

Practice location:
  • Phone: 931-626-2293
  • Fax:
Mailing address:
  • Phone: 931-626-2293
  • Fax: 931-451-7181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier004945182
Identifier TypeMEDICAID
Identifier StateVA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: