Basic Information
| Provider Information | |||||||||
| NPI: | 1225704232 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEYER | ||||||||
| FirstName: | TRACY | ||||||||
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| Credential: | LGPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 BENEFIELD BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6676002494 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1111 BENEFIELD BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6676002494 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2021 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LGP11678 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.