Provider Demographics
NPI:1922545482
Name:TEST, TRACI (PHD, LPC-S)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:TEST
Suffix:
Gender:F
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15922 ELDORADO PKWY STE 500-986
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5836
Mailing Address - Country:US
Mailing Address - Phone:903-819-1848
Mailing Address - Fax:
Practice Address - Street 1:15922 ELDORADO PKWY STE 500-986
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5836
Practice Address - Country:US
Practice Address - Phone:903-819-1848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62868101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor