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General NPI Number Information
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NPI Number | 1033312285
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Entity Type | Individual
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Provider Name | MICHAEL W TRACY LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 6900 N PECOS RD
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89086-4400
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Country | US
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Telephone | 801-888-2935
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 MANSE RD
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City | PAHRUMP
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State | NV
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Zip | 89048-6824
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Country | US
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Telephone | 801-888-2935
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-712
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8566-C
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5970944-3501
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License Number State | UT
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