Tracey R Bourne, L.M.H.C.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH11645 Issued in FL

Practice address

13575 58TH St N Ste 188
Clearwater, FL 33760-3741

Phone

(727) 314-1224

NPI assigned

Apr 24, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 23, 2024 through Feb 23, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Counseling Services of Tampa Bay

  • Professional Counselor
  • Clearwater, FL
  • NPI 1720446909

  Addiction (Substance Use Disorder)

  NPD (past) Authorized official

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

{
    "created_epoch": "1398297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741305600000",
    "number": "1174943526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13575 58TH ST N STE 188",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337603741",
            "telephone_number": "727-314-1224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13575 58TH ST N STE 188",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337603741",
            "telephone_number": "727-314-1224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURNE",
        "first_name": "TRACEY",
        "middle_name": "R",
        "credential": "L.M.H.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-24",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "18886",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH11645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED MENTAL HEALTH COUNSELOR",
            "identifier": "MH11645",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA LICENSED PROFESSIONAL CLINICAL COUNSELOR",
            "identifier": "18886",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlin Boucher, LCSW
• Constantine G Bouchlas, MD
• Vasiliki Boulieris
• Brien M Bourbeau, APRN-C
• Barbara J. Bourland, M. D.
• Bassem Ramzy Boutros, RPH
• Bowen Speech-Language Therapy, LLC
• Cynthia Williams Bowen, M.S., CCC-SLP
• Bowman & Hampsey Mdspa
• Bowman & Hampsey Medical Clinic, Inc

• Mental Health Counselor in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.