Provider Demographics
NPI:1891430914
Name:WASHINGTON, TRACY (LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W MAIN ST UNIT 466
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84049-8020
Mailing Address - Country:US
Mailing Address - Phone:801-842-1492
Mailing Address - Fax:
Practice Address - Street 1:2 S MAIN ST STE 2A-1
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1852
Practice Address - Country:US
Practice Address - Phone:801-266-2485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X, 1041C0700X
UT18914309141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker