| Tracie Johnson, Llc | |
|
211 N Main St Ste 203 Spearfish SD 57783-2646 | |
| (605) 641-7534 | |
| (605) 559-0512 |
| Full Name | Tracie Johnson, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 211 N Main St Ste 203, Spearfish, South Dakota |
| Authorized Official Name and Position | Tracie Bren-clegg (OWNER / CEO) |
| Authorized Official Contact | 6056417534 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tracie Johnson, Llc 211 N Main St Ste 203 Spearfish SD 57783-2646 Ph: (605) 641-7534 | Tracie Johnson, Llc 211 N Main St Ste 203 Spearfish SD 57783-2646 Ph: (605) 641-7534 |
| NPI Number | 1013439579 |
|---|---|
| Provider Enumeration Date | 07/16/2017 |
| Last Update Date | 09/29/2020 |
| Certification Date | 09/29/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013439579 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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