| Doctor Name: | JOHN ROBERT TRACY |
| NPI Number: | 1063829901 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW, LISW |
| License Number: | CSW.00991938 |
| Business Practice Address: | 25 S 15th St Suite 2 Council Bluffs, IA - 515013900 |
| Business Phone Number: | 7123107116 |
| Business Fax Number: | |
| Mailing Address: | 25 S 15th St, Suite 2 COUNCIL BLUFFS |
| State: | IA |
| Postal Code: | 515013900 |
| Phone Number: | 7123107116 |
| Fax Number: | |
| NPI Enumeration Date: | 07/11/2014 |
| NPI Last Update Date: | 05/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | CSW.00991938 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |