Provider Demographics
NPI:1043829278
Name:MCKEOWN, TRACY NANETTE (LPC-C)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:NANETTE
Last Name:MCKEOWN
Suffix:
Gender:F
Credentials:LPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4732 STAG HORN DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2342
Mailing Address - Country:US
Mailing Address - Phone:405-556-0656
Mailing Address - Fax:
Practice Address - Street 1:1777 S YUKON PKWY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4599
Practice Address - Country:US
Practice Address - Phone:405-556-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor