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General NPI Number Information
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NPI Number | 1902284896
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Entity Type | Individual
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Provider Name | TRACEY LOUISE MCCABE
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Gender | Female
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 11/11/2016
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Provider Practice Location Address
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Address Line | 7520 EDINBOROUGH WAY #2315
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City | EDINA
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State | MN
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Zip | 55435-4764
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Country | US
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Telephone | 952-201-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 7308 MOONLIGHT LN #2315
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City | EDEN PRAIRIE
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State | MN
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Zip | 55346-2761
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Country | US
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Telephone | 952-201-9494
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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 | 01486
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License Number State | MN
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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 | 1292
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License Number State | MN
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