Smith, Tracy Lynn
Smith, Tracy Lynn is an individual health care provider with primary practice located at 4407 Maccorkle Ave Se , Charleston WV 25304-2541. She recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as her primary health care specialty. Smith, Tracy Lynn can be contacted via phone (304) 925-0800.Contact Information
Primary practice address
4407 Maccorkle Ave Se
Charleston WV 25304-2541
Phone: (304) 925-0800
Fax: (304) 925-0805
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 785 | West Virginia |
Profile Details
| NPI number | 1417067539 |
|---|---|
| LBN Legal business name | Smith, Tracy Lynn |
| Credentials | Master of Arts (MA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 30th, 2006 |
| Last updated | Aug 13th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417067539 | NPPES |
| West Virginia | MEDICAID | 9205040000 |
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