Provider Demographics
NPI:1427019116
Name:TERPSTRA, TRACY VINCENT (LPC)
Entity type:Individual
Prefix:MR
First Name:TRACY
Middle Name:VINCENT
Last Name:TERPSTRA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 SOMERSET DR SE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-0421
Mailing Address - Country:US
Mailing Address - Phone:423-559-3129
Mailing Address - Fax:423-559-3129
Practice Address - Street 1:2189 APD 40
Practice Address - Street 2:SUITE #1
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37323-6597
Practice Address - Country:US
Practice Address - Phone:423-559-3129
Practice Address - Fax:423-559-3129
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1846101YM0800X
NC5245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441260Medicare UPIN