Tracy Doerr, LPCC/LADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

3801 Issued in MN

Practice address

10464 Hollywood Blvd NW
Coon Rapids, MN 55433-4517

Phone

(612) 900-8934

NPI assigned

Aug 27, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Wild & Free Counseling

  • Community/Behavioral Health Agency
  • Fridley, MN
  • NPI 1689454951

  Multi-Specialty

  Medicare reassignment NPD
• Wild Recovery LLC

  • Substance Abuse Rehabilitation Facility
  • Fridley, MN
  • NPI 1659245330
  NPD Authorized official
• Wild Recovery LLC

  • Substance Abuse Rehabilitation Facility
  • Fridley, MN
  • NPI 1780485854
  NPD Authorized official
• Partners in Recovery, LLC

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1194080234

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1194492025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10464 HOLLYWOOD BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334517",
            "telephone_number": "612-900-8934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10464 HOLLYWOOD BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334517",
            "telephone_number": "612-900-8934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOERR",
        "first_name": "TRACY",
        "credential": "LPCC/LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-27",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303832",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "3801",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "3801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N204188757206",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth A Dileo, MS CCC-A
• Danielle Dire, MD
• DJ-MN Inc
• Robert Dodge, O.D.
• Samantha Leeann Doering, AU.D.
• Wangdu Dolma
• Evan L Domeyer, DO
• Lisa Domeyer, DDS
• Brittney Anne Donley
• Kalil Donzo

• Mental Health Counselor in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.