| Doctor Name: | TRACY LYNN SASHIDHARAN |
| NPI Number: | 1013245737 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.C.P.C. |
| License Number: | 018.0007365 |
| Business Practice Address: | 815 E 5th St Suite 101 Alton, IL - 620026471 |
| Business Phone Number: | 6184635158 |
| Business Fax Number: | 6184746242 |
| Mailing Address: | 815 E 5th St, Suite 101 ALTON |
| State: | IL |
| Postal Code: | 620026471 |
| Phone Number: | 6184635158 |
| Fax Number: | 6184746242 |
| NPI Enumeration Date: | 11/19/2009 |
| NPI Last Update Date: | 11/19/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 018.0007365 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |