TRACIE LYN HANSEN


Address: 560 Fairway Dr, Pocatello, ID 83201-2012
Phone: 2082426669

TRACIE LYN HANSEN (NPI# 1639779523) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1639779523
Entity Type Individual
Full Name TRACIE LYN HANSEN
Other Name TRACIE LYN BURRUP
Credential B.S.
Practice Address 560 Fairway Dr
Pocatello
ID 83201-2012
Practice Telephone 2082426669
Mailing Telephone 2082426669
Enumeration Date 2020-10-29
Last Update Date 2020-10-29
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 175T00000X Peer Specialist CPSS055 ID Other Service Providers

Office Location

Street Address 560 FAIRWAY DR
City POCATELLO
State ID
Zip Code 83201-2012

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1235765330 Timothy Palmer Social Worker 400 S 11th Ave, Ste 204, Pocatello, ID 83201 2020-03-20
1225687759 Hanna Percy Nurse Practitioner 1151 Hospital Way Ste 201, Pocatello, ID 83201 2019-09-07
1659935195 Carol Jane Dillon Counselor 707 North 7th Avenue, Suite D, Pocatello, ID 83201 2019-04-30
1154801595 Mv Pocatello Ent, LLC Otolaryngology 333 N 18th Ave Ste B3, Pocatello, ID 83201 2018-08-15
1306344346 Ruth Anne Patton Social Worker 850 E Young St, Pocatello, ID 83201 2018-01-24
1598289274 Lucas Alexander Bryan Specialist/Technologist 1535 E Terry St, Pocatello, ID 83201 2017-08-03
1205365632 Geno Alan Giovanini Denturist 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 2017-06-08
1518415942 Kelli Fries-geslin Nurse Practitioner 500 South 11 Ave Suite 400, Pocatello, ID 83201 2016-09-14
1346797842 Shailyn Jenkins Specialist/Technologist 665 Warren Ave., Pocatello, ID 83201 2016-09-01
1992258149 Christopher Jared White Social Worker 300 N 7th Ave, Pocatello, ID 83201 2016-07-24
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Taxonomy Information

Taxonomy Code 175T00000X
Grouping Other Service Providers
Classification Peer Specialist

Taxonomy Definition

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
Notes: Source: National Uniform Claim Committee [7/1/2014: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1184113482 Kolleen Marie Wynn-gallipeau Peer Specialist 444 Hospital Way Ste 447, Pocatello, ID 83201-2744 2018-05-02
1750887394 Shawn Grischkowsky Peer Specialist 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 2018-04-03
1760980023 Lisa Gay Johnston Peer Specialist 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 2018-01-31
1811417272 Lauren Elizabeth Ellsworth Peer Specialist 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 2017-06-26

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1306481817 Ability Health and Rehabilitation LLC Peer Specialist 10101 W Overland Rd Ste 110, Boise, ID 83709-1429 2019-11-08
1609426923 Amie Hughes Peer Specialist 4737 S Afton Pl Ste A, Chubbuck, ID 83202-2317 2019-09-18
1073127791 Calm Waters Counseling Pllc Peer Specialist 10108 W Overland Rd Ste A, Boise, ID 83709-1428 2020-09-01
1790307890 Jx2 LLC Peer Specialist 8950 W Emerald St Ste 178, Boise, ID 83704-8296 2020-05-12
1063034437 Inroads, Inc Peer Specialist 3288 E Pine Ave, Meridian, ID 83642-5922 2020-05-08
1356962112 Aaa American Healthcare LLC Peer Specialist 1301 E 17th St, Idaho Falls, ID 83404-6273 2020-05-04
1346878691 Aspen Ministries Syringa Wellness Peer Specialist 1609 S Kimball Ave Ste 200, Caldwell, ID 83605-5196 2020-03-31
1962033399 Lookout Behavioral Health LLC Peer Specialist 7905 N Meadowlark Way Ste A, Coeur D Alene, ID 83815-5041 2020-02-04
1356981419 Lake City Counseling Center Peer Specialist 9705 N Shaw St, Hayden, ID 83835-9716 2020-01-07
1700425600 Center Counseling, LLC Peer Specialist 265 E Chubbuck Rd, Chubbuck, ID 83202-5055 2019-12-26
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Competitor

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City POCATELLO
Zip Code 83201

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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