Provider Demographics
NPI:1043301583
Name:SPENCER, TRACIE B (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:B
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:TWIN MOUNTAIN
Mailing Address - State:NH
Mailing Address - Zip Code:03595-0183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 599
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-0599
Practice Address - Country:US
Practice Address - Phone:603-444-5358
Practice Address - Fax:603-444-0145
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2804101YM0800X
TX14797101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124876OtherCHIP
TX822246OtherBLUE CROSS BLUE SHIELD