National Provider Identifier
Tracy Mickelson, CASAC
Tracy Mickelson, CASAC is listed in the NPPES registry with a primary specialty of Addiction (Substance Use Disorder) Counselor in Elmira, NY and a listed phone number of (607) 733-7661.
Profile Overview
- NPI
- 1639785033
- Provider Type
- Individual
- Primary Specialty
- Addiction (Substance Use Disorder) Counselor
- Enumeration Date
- September 21, 2020
- Last Updated
- September 21, 2020
Practice Location
- 1149 Sullivan St Ste B
- Elmira, NY 14901-1670
Phone: (607) 733-7661
Specialties
- Addiction (Substance Use Disorder) Counselor (101YA0400X)
Full Record
- NPI
- 1639785033
- Entity Type
- Individual
- Last Name
- Mickelson
- First Name
- Tracy
- Credential
- CASAC
- Mailing Street Address
- 1149 Sullivan St Ste B
- Mailing City
- Elmira
- Mailing State
- NY
- Mailing ZIP Code
- 14901-1670
- Mailing Country
- US
- Mailing Phone
- (607) 733-7661
- Mailing Fax
- (607) 733-7675
- Practice Street Address
- 1149 Sullivan St Ste B
- Practice City
- Elmira
- Practice State
- NY
- Practice ZIP Code
- 14901-1670
- Practice Country
- US
- Practice Phone
- (607) 733-7661
- Practice Fax
- (607) 733-7675
- Enumeration Date
- September 21, 2020
- Last Updated
- September 21, 2020
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- September 21, 2020
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Addiction (Substance Use Disorder) Counselor (101YA0400X)