MS. LYNETTE EFFIE TRACY CDP LICSW NPI 1780769216

NPI Information

NPI: 1780769216
Provider Name: MS. LYNETTE EFFIE TRACY, CDP, LICSW
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
1601 E FOURTH PLAIN BLVD
BLDG 17
VANCOUVER, WA
ZIP 98661
Phone: (360) 397-8246
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MS. Lynette Effie Tracy, CDP, LICSW is an addiction (substance use disorder) counselor in Vancouver, WA. MS. Lynette Effie Tracy, CDP, LICSW NPI is 1780769216. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1601 E FOURTH PLAIN BLVD
BLDG 17
VANCOUVER, WA
ZIP 98661-753
Phone: (360) 397-8246
Fax: (360) 397-8450

The enumeration date for this NPI number is 10/25/2006 and was last updated on 6/10/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1041C0700X	Social Worker	Clinical	LW 60363996	WASHINGTON	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	CP00005446	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0000WDBCH	MEDICARE ID-TYPE UNSPECIFIED	OREGON
2	164936	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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