Richard Harvey Tracy, LICSW
Individual provider Active NPI Mental Health Counselor · Cosmos, MN
NPI 1295982338 · NPPES record last updated Aug 20, 2008
Key facts
- NPI
- 1295982338
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 8638 (MN)
- Practice address
- 215 Milky Way Street South
Cosmos, MN 56228 - Phone
- (320) 877-7220
- Fax
- (320) 877-7479
- NPI assigned
- Aug 20, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8638 | MN | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwestern Minnesota Adult Mental Health Consortium | Mental Health | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 8638 | MN | Yes |
| Professional Counselor | 101YP2500X | 8638 | MN |
Addresses
Primary practice location
215 Milky Way Street South
Cosmos, MN 56228
Mailing address
215 Milky Way Street South
Cosmos, MN 56228
Phone (320) 877-7220
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 274557000 | Medicaid | MN |
Other providers in Cosmos, MN
- Mackenzie Rose Swant
- Abbigale Marie Thomas
- Mariah Thomas
- Brittney Thompson
- Catherine Elizabeth Towne
- Lance Triplett
- Evelyn Marie Waters
- Julia Marie Woelfel
- Woodland Centers
All providers in Cosmos, MN · Mental Health Counselor in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.