Provider Demographics
NPI:1336651975
Name:ALLEN, TRACY LYNN (LPCC-S)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:FREESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1234 RIDGEWOOD DR STE C
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2695
Mailing Address - Country:US
Mailing Address - Phone:419-494-7141
Mailing Address - Fax:
Practice Address - Street 1:1234 RIDGEWOOD DR STE C
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2695
Practice Address - Country:US
Practice Address - Phone:419-494-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1700281101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor