Provider Demographics
NPI:1760508626
Name:BACKENCAMP, TRACY M (LIMHP)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:M
Last Name:BACKENCAMP
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-7832
Mailing Address - Country:US
Mailing Address - Phone:308-379-4209
Mailing Address - Fax:
Practice Address - Street 1:346 LARKSPUR LN
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-7832
Practice Address - Country:US
Practice Address - Phone:308-379-4209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NE1058101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1760508626Other01
NE47077707526Medicaid