Provider Demographics
NPI:1992881296
Name:BARNES, TRACIE L (LMHC)
Entity type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:L
Last Name:BARNES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6956 STATE HIGHWAY 56
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3504
Mailing Address - Country:US
Mailing Address - Phone:315-268-0264
Mailing Address - Fax:315-268-8001
Practice Address - Street 1:6956 STATE HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3504
Practice Address - Country:US
Practice Address - Phone:315-268-0264
Practice Address - Fax:315-268-8001
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health