| Tracy Milstead, Llc | |
|
207 Winona Way Kingsland GA 31548-6581 | |
| (904) 310-4446 | |
| (888) 919-3114 |
| Full Name | Tracy Milstead, Llc |
|---|---|
| Speciality | Counselor |
| Location | 207 Winona Way, Kingsland, Georgia |
| Authorized Official Name and Position | Tracy Milstead (OWNER) |
| Authorized Official Contact | 9043104446 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tracy Milstead, Llc 207 Winona Way Kingsland GA 31548-6581 Ph: (904) 310-4446 | Tracy Milstead, Llc 207 Winona Way Kingsland GA 31548-6581 Ph: (904) 310-4446 |
| NPI Number | 1053189878 |
|---|---|
| Provider Enumeration Date | 12/12/2023 |
| Last Update Date | 12/12/2023 |
| Certification Date | 12/11/2023 |
| Medicare PECOS PAC ID | 8527418987 |
|---|---|
| Medicare Enrollment ID | O20231227001409 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053189878 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Tracy Milstead |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710446570 PECOS PAC ID: 9436509890 Enrollment ID: I20231227001692 |
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