Provider Demographics
NPI:1124512462
Name:PELLA, TRACY (LMHP, NCSP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:PELLA
Suffix:
Gender:F
Credentials:LMHP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 F ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NE
Mailing Address - Zip Code:68418-4140
Mailing Address - Country:US
Mailing Address - Phone:402-782-3535
Mailing Address - Fax:
Practice Address - Street 1:425 F ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NE
Practice Address - Zip Code:68418-4140
Practice Address - Country:US
Practice Address - Phone:402-782-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health