Provider Demographics
NPI:1861745382
Name:CAMLIN, TRACIE LYNN (LCAC)
Entity type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:LYNN
Last Name:CAMLIN
Suffix:
Gender:F
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 MINNESOTA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66101-2850
Mailing Address - Country:US
Mailing Address - Phone:913-281-1995
Mailing Address - Fax:913-281-2317
Practice Address - Street 1:630 MINNESOTA AVE STE 204
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101-2850
Practice Address - Country:US
Practice Address - Phone:913-281-1995
Practice Address - Fax:913-281-2317
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)