Provider Demographics
NPI:1417254467
Name:MCCULLICK, TRACEY HELENE (LPC)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:HELENE
Last Name:MCCULLICK
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 1:5119 FAIRVIEW DR
Mailing Address - Street 2:B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-5425
Mailing Address - Country:US
Mailing Address - Phone:512-452-0063
Mailing Address - Fax:
Practice Address - Street 1:5119 FAIRVIEW DR
Practice Address - Street 2:B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-5425
Practice Address - Country:US
Practice Address - Phone:512-452-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional