Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801089920 | MI |
NPI | 1003060278 |
---|---|
Provider Name | Ms. Tamara Lynn Tracy |
First Address | Farmington Hills, MI 48334-2579 |
Second Address | Farmington Hills, MI 48334-2579 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2008 |
Last Update Date | 15/03/2021 |