Provider Demographics
NPI:1073284022
Name:BURNETT-GREENUP, TRACEY LEIGH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LEIGH
Last Name:BURNETT-GREENUP
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 1:1400 EL CAMINO VILLAGE DR APT 1213
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3059
Mailing Address - Country:US
Mailing Address - Phone:713-542-6424
Mailing Address - Fax:
Practice Address - Street 1:1400 EL CAMINO VILLAGE DR APT 1213
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3059
Practice Address - Country:US
Practice Address - Phone:713-542-6424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health