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NPI Code Detail

MEDICARE: MR. TRACY JAMES MAYES MA LCPC

MEDICARE: MR. TRACY JAMES MAYES MA LCPC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1922296615
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TRACY JAMES MAYES MA LCPC
Provider Business Mailing Address
First Line : 8770 W BRYN MAWR AVE STE 1300
Second Line :
City : CHICAGO
State : IL
Zip : 60631-3557
Country : US
Telephone Number : 636-734-9457
Fax Number :
Provider Business Practice Location Address
First Line : 8770 W BRYN MAWR AVE STE 1300
Second Line :
City : CHICAGO
State : IL
Zip : 60631-3557
Country : US
Telephone Number : 636-734-9457
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2007
Last Update Date : 03/12/2025

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