Provider Demographics
NPI:1376206300
Name:BALLINGER, TRACY LEE (MS, LPC, LADC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:MS, LPC, LADC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LEE
Other - Last Name:FICKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13775 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-3247
Mailing Address - Country:US
Mailing Address - Phone:918-557-1640
Mailing Address - Fax:
Practice Address - Street 1:5310 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5018
Practice Address - Country:US
Practice Address - Phone:918-600-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK80101YA0400X
OK1914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)