Provider Demographics
NPI:1013402890
Name:SKRIPKA, TRACY LEIGH
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEIGH
Last Name:SKRIPKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 FAIRMONT PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4511
Mailing Address - Country:US
Mailing Address - Phone:281-769-2238
Mailing Address - Fax:
Practice Address - Street 1:6021 FAIRMONT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4511
Practice Address - Country:US
Practice Address - Phone:281-760-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65373101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor