Organization
TRACY BANE LCSW
Active
Other names
Tracy Bane LCSW
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY BANE LCSW (OWNER)
(850) 894-0061
Entity
Organization
Contact information
Practice address
3201 SHAMROCK ST S STE 103, TALLAHASSEE, FL 32309-3349
(850) 894-0061
(850) 894-0062
Mailing address
3201 SHAMROCK ST S STE 103, TALLAHASSEE, FL 32309-3349
(850) 894-0061
(850) 894-0062
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
766468100
—
FL
Enumeration date
05/20/2019
Last updated
05/20/2019
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