Individual
TRACY DENISE TRUMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3700 MIDWAY DR, BAKER CITY, OR 97814-1466
(541) 523-8320
(541) 523-8325
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12-P-10
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
22-QMHA-R-2116
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5494176
ODL
OR
Enumeration date
02/08/2016
Last updated
11/23/2022
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