Basic Information
| Provider Information | |||||||||
| NPI: | 1740477744 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIFFIN | ||||||||
| FirstName: | TRACIE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LICENSED PROFESSIONA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 STIMFEL DR | ||||||||
| Address2: | |||||||||
| City: | UNIONTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307549611 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1950 STIMFEL DR | ||||||||
| Address2: | |||||||||
| City: | UNIONTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2342620035 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2007 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0600520 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.