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General NPI Number Information
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NPI Number | 1881983344
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Entity Type | Individual
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Provider Name | TRACEY DENISE FILIPASIC PCC-S
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Gender | Female
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 5930 HEISLEY RD
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City | MENTOR
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State | OH
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Zip | 44060-1834
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Country | US
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Telephone | 440-639-3507
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Fax |
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Provider Business Mailing Address
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Address Line | 5930 HEISLEY RD
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City | MENTOR
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State | OH
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Zip | 44060-1834
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Country | US
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Telephone | 440-639-3507
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 011190
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E0004213-SUPV
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License Number State | OH
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