MEDICARE: TRACEY HARRIS MSW, LCSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	171M00000X	Case Manager/Care Coordinator
3	172V00000X	Community Health Worker
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1639843345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY HARRIS MSW, LCSW

Provider Business Mailing Address
First Line	:	4025 RAWLINS ST
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-1900
Country	:	US
Telephone Number	:	307-426-4797
Fax Number	:

Provider Business Practice Location Address
First Line	:	427 S 21ST ST
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-4323
Country	:	US
Telephone Number	:	307-459-3670
Fax Number	:

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

Provider Enumeration Date	:	08/05/2021
Last Update Date	:	01/30/2024

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