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NPI Code Detail

MEDICARE: JOSHUA WARD TRACY LMSW

MEDICARE: JOSHUA WARD TRACY LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerLMSW-39746ID

General Provider Information

NPI Number : 1306438767
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA WARD TRACY LMSW
Provider Business Mailing Address
First Line : PO BOX 4793
Second Line :
City : POCATELLO
State : ID
Zip : 83205-4793
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 151 N 3RD AVE STE 330
Second Line :
City : POCATELLO
State : ID
Zip : 83201-6369
Country : US
Telephone Number : 208-244-8771
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2021
Last Update Date : 02/08/2021

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Directions to “ JOSHUA WARD TRACY LMSW” Practice Location

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