Tracy L Dantzler, SUDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP00002768 Issued in WA

Practice address

10305 E Montgomery Dr
Spokane Valley, WA 99206-4220

Phone

(509) 418-2108

Fax

(509) 315-9386

NPI assigned

Oct 15, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Tracy L Tucker Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Sequoia Detox Centers LLC

  • Substance Abuse Rehabilitation Facility
  • Spokane Valley, WA
  • NPI 1487289567
  NPD
• Spokane Falls Recovery Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Spokane, WA
  • NPI 1093352338
  NPD (past)

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

{
    "created_epoch": "1571097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1568004182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E MAGNESIUM RD STE 101",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992085901",
            "telephone_number": "509-368-9021",
            "fax_number": "509-474-1796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10305 E MONTGOMERY DR",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992064220",
            "telephone_number": "509-418-2108",
            "fax_number": "509-315-9386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANTZLER",
        "first_name": "TRACY",
        "middle_name": "L",
        "credential": "SUDP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-15",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00002768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "TUCKER",
            "middle_name": "L",
            "credential": "SUDP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Damom & Magnuson Orthodontics
• Paul L Damon, D.D.S.
• Peter Huu Dang, D.D.S.
• Brittney Quionna Daniels
• Erin Elizabeth Daniels, DSW, LICSW, MA
• Nicole Darcy
• Darrin P Rich DDS PS
• Shaelynn Olivia Darwood
• Desirae D Dau, LMP
• Aubrey Dauber, PHD

• Addiction (Substance Use Disorder) Counselor in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.

Verify at the official NPI Registry.