Provider Demographics
NPI:1356641625
Name:TRACY, NANCY BOOKER (LPC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:BOOKER
Last Name:TRACY
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 1:635 STONER AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4124
Mailing Address - Country:US
Mailing Address - Phone:318-424-4357
Mailing Address - Fax:318-424-4355
Practice Address - Street 1:635 STONER AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4124
Practice Address - Country:US
Practice Address - Phone:318-424-4357
Practice Address - Fax:318-424-4355
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional