MEDICARE: DIANA TRACY RMHCI

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		FL

General Provider Information

NPI Number	:	1578327235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA TRACY RMHCI

Provider Business Mailing Address
First Line	:	26246 WESLEY CHAPEL BLVD # 2016
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33559-7206
Country	:	US
Telephone Number	:	813-803-4957
Fax Number	:

Provider Business Practice Location Address
First Line	:	26246 WESLEY CHAPEL BLVD # 2016
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33559-7206
Country	:	US
Telephone Number	:	813-803-4957
Fax Number	:

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

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/12/2024

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