Provider Demographics
NPI:1699753350
Name:VANTASSEL, TRACEY (MSED, LPCC, LSW)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:VANTASSEL
Suffix:
Gender:F
Credentials:MSED, LPCC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1834
Mailing Address - Country:US
Mailing Address - Phone:330-759-0276
Mailing Address - Fax:330-759-0030
Practice Address - Street 1:997 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4223
Practice Address - Country:US
Practice Address - Phone:330-758-0101
Practice Address - Fax:330-758-0128
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0002395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional