Tracy Blad, MA,LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MT4965 Issued in FL

Practice address

2201 NW Corporate Blvd Ste 101
Boca Raton, FL 33431-7337

Phone

(561) 617-8751

Fax

(561) 423-0711

NPI assigned

Aug 21, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, MN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Marriage and Family Therapist

Education

Other, 2015

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Nesting Space Therapy PLLC

  • Marriage & Family Therapist
  • North Branch, MN
  • NPI 1972396851
  Medicare reassignment NPD
• Healing Panda Boca Raton LLC

  dba Ellie Mental Health Boca Raton

  • Mental Health Counselor
  • Boca Raton, FL
  • NPI 1053020271
  NPD

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1871019919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28301 HUMBER ST NE",
            "city": "NORTH BRANCH",
            "state": "MN",
            "postal_code": "550566353",
            "telephone_number": "651-808-0445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 NW CORPORATE BLVD STE 101",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334317337",
            "telephone_number": "561-617-8751",
            "fax_number": "561-423-0711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "28301 Humber St NE",
            "address_purpose": "LOCATION",
            "city": "North Branch",
            "state": "MN",
            "postal_code": "550566353",
            "country_code": "US",
            "telephone_number": "651-808-0445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAD",
        "first_name": "TRACY",
        "credential": "MA,LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-21",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "2917",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "MT4965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blackbird Pharmacy, LLC
• Max Blackburn, PT, DPT
• Jennifer Ann Blacklock, PSY.D.
• Leslie Blackman, MA CCC, SLP
• Danielle Marie Blackwell
• Jennifer Blair, PSY.D.
• Ashley Blake
• Adelda Blanc
• Dalia Maria Blanco
• J Joaquin Blanco, MD

• Marriage & Family Therapist in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Marriage & Family Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.