Provider Demographics
NPI:1548682883
Name:MINCKS, TRACIE (MS, LPC-S, CCTP)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:MINCKS
Suffix:
Gender:F
Credentials:MS, LPC-S, CCTP
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:
Other - Last Name:ARMAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-S, NCC
Mailing Address - Street 1:13367 KEVIN RD
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6835
Mailing Address - Country:US
Mailing Address - Phone:504-606-1503
Mailing Address - Fax:985-781-3754
Practice Address - Street 1:38105 POST OFFICE RD STE 8
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4296
Practice Address - Country:US
Practice Address - Phone:225-402-2436
Practice Address - Fax:225-255-2820
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5178101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional