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General NPI Number Information
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NPI Number | 1104059054
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Entity Type | Individual
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Provider Name | TRACY LYNN ROE M.A., L.C.P.C., NCC
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Gender | Female
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 3350 W AMERICANA TER STE 330C
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City | BOISE
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State | ID
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Zip | 83706-2547
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Country | US
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Telephone | 208-866-3971
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 N BOGUS BASIN RD APT D103
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City | BOISE
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State | ID
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Zip | 83702-0976
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Country | US
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Telephone | 208-866-3971
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 18781
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC-4651
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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