Provider Demographics
NPI:1699279174
Name:HASTINGS, TRACI JEAN (LMHP)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:JEAN
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:JEAN
Other - Last Name:LICHTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHP
Mailing Address - Street 1:4215 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4902
Mailing Address - Country:US
Mailing Address - Phone:308-635-3696
Mailing Address - Fax:308-635-0680
Practice Address - Street 1:4215 AVENUE I
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4902
Practice Address - Country:US
Practice Address - Phone:308-635-3696
Practice Address - Fax:308-635-0680
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health