Provider Demographics
NPI:1275160038
Name:MEADOR, TRACEY (LPC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:MEADOR
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 1:798 COUNTY ROAD 4191
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-7964
Mailing Address - Country:US
Mailing Address - Phone:936-552-1009
Mailing Address - Fax:
Practice Address - Street 1:338 N UNIVERSITY DR STE 206
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-5123
Practice Address - Country:US
Practice Address - Phone:936-552-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional