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General NPI Number Information
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NPI Number | 1396949426
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Entity Type | Individual
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Provider Name | TRACY THERESA EHRHARDT LCPC, ATR-BC
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Gender | Female
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3550 COLLEGE AVE. SUITE C
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City | ALTON
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State | IL
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Zip | 62002-5008
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Country | US
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Telephone | 618-463-5927
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Fax |
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Provider Business Mailing Address
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Address Line | 66 SANTA ANITA DR
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City | MARYVILLE
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State | IL
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Zip | 62062-1928
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Country | US
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Telephone | 618-288-6009
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | IL
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