Provider Demographics
NPI:1053978833
Name:TRACY, CRYSTAL (CMHW - WRAPAROUND)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:CMHW - WRAPAROUND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6066
Mailing Address - Country:US
Mailing Address - Phone:317-882-5122
Mailing Address - Fax:
Practice Address - Street 1:603 E WASHINGTON ST STE 900
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2646
Practice Address - Country:US
Practice Address - Phone:317-635-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health