Provider Demographics
NPI:1144759820
Name:HALLE, TRACY L (LMHC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:HALLE
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 1:165 E GROVE ST STE B
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2737
Mailing Address - Country:US
Mailing Address - Phone:800-273-6277
Mailing Address - Fax:888-978-4883
Practice Address - Street 1:165 E GROVE ST STE B
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2737
Practice Address - Country:US
Practice Address - Phone:800-273-6277
Practice Address - Fax:888-978-4883
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health