Provider Demographics
NPI:1306328414
Name:PARUS, TRACY LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:PARUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:HOLLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:120 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1607
Mailing Address - Country:US
Mailing Address - Phone:812-463-4550
Mailing Address - Fax:812-450-0077
Practice Address - Street 1:120 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1607
Practice Address - Country:US
Practice Address - Phone:812-426-9372
Practice Address - Fax:812-858-4545
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1306328414101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health