=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780291849
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRACY MAYES PSYCHOTHERAPY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2020
-----------------------------------------------------
Last Update Date | 03/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8770 W BRYN MAWR AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-440-4378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8770 W BRYN MAWR AVE STE 1300
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60631-3557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-734-9457
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. TRACY JAMES MAYES
-----------------------------------------------------
Credential | MA LCPC
-----------------------------------------------------
Telephone | 636-734-9457
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------