Provider Demographics
NPI:1437299146
Name:FLICK, TRACI (MED, CRC, PC)
Entity type:Individual
Prefix:MS
First Name:TRACI
Middle Name:
Last Name:FLICK
Suffix:
Gender:F
Credentials:MED, CRC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5873 STATE ROUTE 45
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-9316
Mailing Address - Country:US
Mailing Address - Phone:330-424-3719
Mailing Address - Fax:330-424-3723
Practice Address - Street 1:5873 STATE ROUTE 45
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-9316
Practice Address - Country:US
Practice Address - Phone:330-424-3719
Practice Address - Fax:330-424-3723
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00043657101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor