Provider Demographics
NPI:1033978713
Name:MCDANIEL, TRACY (LCDC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W MULBERRY ST STE 15
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-1940
Mailing Address - Country:US
Mailing Address - Phone:469-253-4487
Mailing Address - Fax:207-245-9532
Practice Address - Street 1:201 W MULBERRY ST STE 15
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1940
Practice Address - Country:US
Practice Address - Phone:469-253-4487
Practice Address - Fax:207-245-9532
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16883101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)