Provider Demographics
NPI:1396407151
Name:ZAVALETA, TRACY LYNN (LSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:ZAVALETA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N MORTON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-9734
Mailing Address - Country:US
Mailing Address - Phone:317-992-9212
Mailing Address - Fax:317-534-1195
Practice Address - Street 1:2000 N MORTON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-9734
Practice Address - Country:US
Practice Address - Phone:317-992-9212
Practice Address - Fax:317-534-1195
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009462A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty