Provider Demographics
NPI:1487060794
Name:TAYLOR, TRACEY (LPC, NCC, CRC, CAADC)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC, NCC, CRC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-0347
Mailing Address - Country:US
Mailing Address - Phone:814-807-2746
Mailing Address - Fax:
Practice Address - Street 1:262 CHESTNUT ST STE 1
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3302
Practice Address - Country:US
Practice Address - Phone:814-807-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007192101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103081417001Medicaid