Provider Demographics
NPI:1861995433
Name:PANNUNZIO, TRACY LYNETTE (LPC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNETTE
Last Name:PANNUNZIO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-1839
Mailing Address - Country:US
Mailing Address - Phone:307-338-8099
Mailing Address - Fax:307-333-7321
Practice Address - Street 1:407 W 27TH AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1839
Practice Address - Country:US
Practice Address - Phone:307-338-8099
Practice Address - Fax:307-333-7321
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1025101YM0800X
NE2478101YP2500X
WY1762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health