Tracy Daniels, CSAC, LPC, ICS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

11389 Issued in WI

Practice address

1717 Taylor Ave
Racine, WI 53403-2405

Phone

(262) 638-6674

Fax

(262) 638-6540

NPI assigned

Nov 22, 2016

Last updated

Jul 26, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1114460268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5735 DURAND AVE STE A",
            "city": "MT PLEASANT",
            "state": "WI",
            "postal_code": "534065011",
            "telephone_number": "262-598-1392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 TAYLOR AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534032405",
            "telephone_number": "262-638-6674",
            "fax_number": "262-638-6540"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5735 Durand Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "MT Pleasant",
            "state": "WI",
            "postal_code": "534065011",
            "country_code": "US",
            "telephone_number": "262-598-1392",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DANIELS",
        "first_name": "TRACY",
        "credential": "CSAC, LPC, ICS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-22",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "11389",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "8036",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10062879",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dana R. Trotter MD SC
• Daniels Chiropractic Office Inc
• Daniel Bruce Daniels, D.C.
• Donald Thomas Daniels, D.C.
• John Bernard Daniels, D.C.
• Daniel Dashner, LCSW, CSAC
• Donna R Daufenbach, MD
• Glenn S Davis, M.D.
• Jakia Mashay Davis, LPC-IT
• Shaniece Davis

• Addiction (Substance Use Disorder) Counselor in Racine, WI
• Providers in Racine, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.