Active NPI
Tracey Mack
- Professional Counselor
- Glen Burnie, MD
National Provider Identifier
1245756121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LC8066
- Practice address
- 1406 Crain Hwy S Ste 104
Glen Burnie, MD 21061-4086 - Phone
- (410) 766-6624
- NPI assigned
- Aug 22, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LC8066 | MD | |
| Professional Counselor | 101YP2500X | LC8066 | MD | Primary |
Addresses
Primary practice location
1406 Crain Hwy S Ste 104
Glen Burnie, MD 21061-4086
Mailing address
1406 Crain Hwy S Ste 104
Glen Burnie, MD 21061-4086
Phone (410) 766-6624
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC8066 | MD | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1245756121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1406 CRAIN HWY S STE 104",
"city": "GLEN BURNIE",
"state": "MD",
"postal_code": "210614086",
"telephone_number": "410-766-6624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1406 CRAIN HWY S STE 104",
"city": "GLEN BURNIE",
"state": "MD",
"postal_code": "210614086",
"telephone_number": "410-766-6624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "TRACEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-22",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MD",
"license": "LC8066",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MD",
"license": "LC8066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Burnie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.