Provider Demographics
NPI:1285953034
Name:SOOS, TRACY DIANE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:DIANE
Last Name:SOOS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N SEMINARY AVE
Mailing Address - Street 2:UNIT L
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-2980
Mailing Address - Country:US
Mailing Address - Phone:815-459-0499
Mailing Address - Fax:815-788-0115
Practice Address - Street 1:1400 N SEMINARY AVE
Practice Address - Street 2:UNIT L
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-2980
Practice Address - Country:US
Practice Address - Phone:815-459-0499
Practice Address - Fax:815-788-0115
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22650101YA0400X
IL180007500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)