Tracy Michelle Gustafson, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801080472 Issued in MI

Practice address

1803 Whites Rd
Suite 5
Kalamazoo, MI 49008-2883

Phone

(269) 345-5776

Fax

(269) 345-4011

NPI assigned

Feb 24, 2006

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

• Tracy Michelle Datte Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Samaritas Lutheran Social Services of Michigan

  • Addiction (Substance Use Disorder) Counselor
  • Charlotte, MI
  • NPI 1972860005
  NPD (past)

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361836800000",
    "number": "1508832056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 WHITES RD",
            "address_2": "SUITE 5",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490082883",
            "telephone_number": "269-345-5776",
            "fax_number": "269-345-4011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1803 WHITES RD",
            "address_2": "SUITE 5",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490082883",
            "telephone_number": "269-345-5776",
            "fax_number": "269-345-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "TRACY",
        "middle_name": "MICHELLE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-24",
        "last_updated": "2013-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801080472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "DATTE",
            "middle_name": "MICHELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Vishal Gupta, M.D.
• Donald Wayne Gusfa, DO
• Colette Gushurst, M.D.
• Janette Gustafson
• John G Gustafson, MD
• Alan Carl Gustavson, R.PH.
• Barbara W. Gustin, LMSW
• Emily Guthrie
• Jaeson Gutierrez, RBT
• Moriah Guy, LPC

• Clinical Social Worker in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2013; 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.