=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679462444
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACEY LYNN CORBETT LLPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2025
-----------------------------------------------------
Last Update Date | 06/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2031 RAMBLING RD # 7
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49008-1632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-873-7787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5455 GULL RD # D120
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49048-7654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-873-7787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6451015641
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------