MEDICARE: TRACY NORCROSS LLPC

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	N966464	MI

General Provider Information

NPI Number	:	1528692779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY NORCROSS LLPC

Provider Business Mailing Address
First Line	:	2430 CAMELOT CT SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-6001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2430 CAMELOT CT SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-6001
Country	:	US
Telephone Number	:	616-219-0052
Fax Number	:

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

Provider Enumeration Date	:	02/26/2020
Last Update Date	:	02/26/2020

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Directions to “ TRACY NORCROSS LLPC” Practice Location

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