Provider Demographics
NPI:1992199632
Name:FLANDERS, TRACY (MT-BC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:FLANDERS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6222 ADACROFT DR SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-7801
Mailing Address - Country:US
Mailing Address - Phone:616-550-9913
Mailing Address - Fax:
Practice Address - Street 1:6222 ADACROFT DR SE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-7801
Practice Address - Country:US
Practice Address - Phone:616-550-9913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker