Individual
JACOB KENNETH TRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, NCC
Contact information
Practice address
410 E LAKE STREET, SUITE 100, PETOSKEY, MI 49770
(616) 889-4104
Mailing address
410 E LAKE STREET, SUITE 100, PETOSKEY, MI 49770
(616) 889-4104
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401015019
MI
Other
Enumeration date
04/12/2018
Last updated
04/12/2018
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