Provider Demographics
NPI:1548369580
Name:MACH, TRACY P (LPC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:P
Last Name:MACH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-2244
Mailing Address - Country:US
Mailing Address - Phone:979-966-0711
Mailing Address - Fax:979-966-0711
Practice Address - Street 1:250 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2244
Practice Address - Country:US
Practice Address - Phone:979-966-0711
Practice Address - Fax:979-966-0711
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17606101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional