Healthcare Provider Details

I. General information

NPI: 1063789725
Provider Name (Legal Business Name): TRACY MARIE METZ CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 10/25/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 NE 41ST ST STE 200
VANCOUVER WA
98662-6772
US

IV. Provider business mailing address

12821 NE 43RD CIR
VANCOUVER WA
98682-6492
US

V. Phone/Fax

Practice location:
  • Phone: 360-512-3856
  • Fax:
Mailing address:
  • Phone: 360-901-3699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP 60233655
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61250557
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: