Provider Demographics
NPI:1851937908
Name:MARTIN, TRACY L (LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:ENGLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1205
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-1205
Mailing Address - Country:US
Mailing Address - Phone:270-791-5528
Mailing Address - Fax:270-526-2218
Practice Address - Street 1:108 ENSMINGER DR STE A
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1157
Practice Address - Country:US
Practice Address - Phone:270-659-0035
Practice Address - Fax:270-629-4880
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2545431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1851937908Medicaid