Provider Demographics
NPI:1407336662
Name:MAYHEW, TRACY GALE (LPC)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:GALE
Last Name:MAYHEW
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 1:4980 SEAN HAGGERTY DR APT 223
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3345
Mailing Address - Country:US
Mailing Address - Phone:915-201-9538
Mailing Address - Fax:
Practice Address - Street 1:4980 SEAN HAGGERTY DR APT 223
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-3345
Practice Address - Country:US
Practice Address - Phone:915-201-9538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64141101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional