Provider Demographics
NPI:1366983207
Name:MUNDEN, TRACI LEANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:TRACI
Middle Name:LEANN
Last Name:MUNDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 BEDFORD LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3732
Mailing Address - Country:US
Mailing Address - Phone:972-746-0440
Mailing Address - Fax:
Practice Address - Street 1:5680 FRISCO SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3300
Practice Address - Country:US
Practice Address - Phone:469-535-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-11
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60178104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker