Provider Demographics
NPI:1114305786
Name:SHERRON-SPIES, TRACEY NICHOLE (LMFT)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:NICHOLE
Last Name:SHERRON-SPIES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:T
Other - Middle Name:NICHOLE
Other - Last Name:SPIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:938 MOUNTAIN CREST DR # G
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-8921
Mailing Address - Country:US
Mailing Address - Phone:903-715-2603
Mailing Address - Fax:
Practice Address - Street 1:212 EAST DUKE STREET
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743
Practice Address - Country:US
Practice Address - Phone:580-522-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No171M00000XOther Service ProvidersCase Manager/Care Coordinator