MEDICARE: STEPHEN N TRACY LMFT NCP

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	106H00000X	Marriage & Family Therapist	781	NV

General Provider Information

NPI Number	:	1578628590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN N TRACY LMFT NCP

Provider Business Mailing Address
First Line	:	7812 WATERFALLS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6707
Country	:	US
Telephone Number	:	702-258-2648
Fax Number	:	702-651-5843

Provider Business Practice Location Address
First Line	:	7812 WATERFALLS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6707
Country	:	US
Telephone Number	:	702-258-2648
Fax Number	:	702-651-5843

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	10/20/2016

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