Healthcare Provider Details

I. General information

NPI: 1255522272
Provider Name (Legal Business Name): TRACY LYNN HORTMAN LISW-CP,CMSW,LMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

1000 FERN ST SW UNIT C206
OLYMPIA WA
98502-6123
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-2418
  • Fax: 206-764-2105
Mailing address:
  • Phone: 402-916-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4073
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1447
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW70040157
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14526
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: