Provider Demographics
NPI:1043301583
Name:SPENCER, TRACIE B (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:B
Last Name:SPENCER
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 1:1100 STONE ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-5494
Mailing Address - Country:US
Mailing Address - Phone:903-986-9114
Mailing Address - Fax:903-988-0243
Practice Address - Street 1:1100 STONE ROAD
Practice Address - Street 2:SUITE 102 BEHAVIORAL EMOTIONAL COUNSELING SERVICES
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-5494
Practice Address - Country:US
Practice Address - Phone:903-986-9114
Practice Address - Fax:903-988-0243
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14797101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124876OtherCHIP
TX822246OtherBLUE CROSS BLUE SHIELD