Tracy Pualani Takaki, BC-DMT, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180006573 Issued in IL

Practice address

1111 E Addison Ave
Lombard, IL 60148-3774

Phone

(773) 318-7331

NPI assigned

Mar 31, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Tracy Lani Terselic Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Creative One Studio, Inc.

  • Community/Behavioral Health Agency
  • Villa Park, IL
  • NPI 1306084991
  NPD (past) Authorized official

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

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690675200000",
    "number": "1386816296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 E ADDISON AVE",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601483774",
            "telephone_number": "773-318-7331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 E ADDISON AVE",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601483774",
            "telephone_number": "773-318-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKAKI",
        "first_name": "TRACY",
        "middle_name": "PUALANI",
        "name_prefix": "Ms.",
        "credential": "BC-DMT, LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-31",
        "last_updated": "2023-07-30",
        "certification_date": "2021-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180006573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "TERSELIC",
            "middle_name": "LANI",
            "prefix": "MS.",
            "credential": "BC-DMT, LCPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Razia Tabrezi
• Tahira Tabrezi
• Tahseen Khaleel MD PLLC
• Nikita B Tailor, PT
• Amena Syeda Tajammul
• David Yi Tam, D.C.
• Mia Angela Taormina, D.O.
• Aasma Tariq
• Dorothy Tate
• Farah Tazeen, M.D.

• Professional Counselor in Lombard, IL
• Providers in Lombard, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.