Provider Demographics
NPI:1114637253
Name:TRACY, STEVEN ANTHONY (LMHCA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANTHONY
Last Name:TRACY
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17424 122ND AVE E UNIT G105
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9036
Mailing Address - Country:US
Mailing Address - Phone:425-770-9195
Mailing Address - Fax:
Practice Address - Street 1:17424 122ND AVE E UNIT G105
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-9036
Practice Address - Country:US
Practice Address - Phone:425-770-9195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61640235101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health