Provider Demographics
NPI:1316652100
Name:TRACY ULRICH, LLC
Entity type:Organization
Organization Name:TRACY ULRICH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:802-730-6539
Mailing Address - Street 1:282 ELMORE POND RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:VT
Mailing Address - Zip Code:05680-4033
Mailing Address - Country:US
Mailing Address - Phone:802-730-6539
Mailing Address - Fax:
Practice Address - Street 1:138 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843-7046
Practice Address - Country:US
Practice Address - Phone:802-730-6539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012555Medicaid