MEDICARE: MR. TRACY VINCENT TERPSTRA LPC

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
1	101YM0800X	Mental Health Counselor	1846	TN
2	101YM0800X	Mental Health Counselor	5245	NC

General Provider Information

NPI Number	:	1427019116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TRACY VINCENT TERPSTRA LPC

Provider Business Mailing Address
First Line	:	3290 SOMERSET DR SE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-0421
Country	:	US
Telephone Number	:	423-559-3129
Fax Number	:	423-559-3129

Provider Business Practice Location Address
First Line	:	2189 APD 40
Second Line	:	SUITE #1
City	:	CLEVELAND
State	:	TN
Zip	:	37323-6597
Country	:	US
Telephone Number	:	423-559-3129
Fax Number	:	423-559-3129

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/09/2007

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