Provider Demographics
NPI:1063789725
Name:METZ, TRACY MARIE (CDP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:MARIE
Last Name:METZ
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12821 NE 43RD CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-6492
Mailing Address - Country:US
Mailing Address - Phone:360-901-3699
Mailing Address - Fax:
Practice Address - Street 1:7600 NE 41ST ST STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6772
Practice Address - Country:US
Practice Address - Phone:360-512-3856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61250557101YM0800X
WACP 60233655101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)