Provider Demographics
NPI:1861744906
Name:OLIVER, TRACY (LPCC, LMHC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LPCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 OAK ST
Mailing Address - Street 2:
Mailing Address - City:YALAHA
Mailing Address - State:FL
Mailing Address - Zip Code:34797-3006
Mailing Address - Country:US
Mailing Address - Phone:859-779-2057
Mailing Address - Fax:
Practice Address - Street 1:17 OAK ST
Practice Address - Street 2:
Practice Address - City:YALAHA
Practice Address - State:FL
Practice Address - Zip Code:34797-3006
Practice Address - Country:US
Practice Address - Phone:859-779-2057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-14
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional