Provider Demographics
NPI:1437365418
Name:LAFORTY, TRACY BAHAKEL
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:BAHAKEL
Last Name:LAFORTY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:BUMPUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 88
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124
Mailing Address - Country:US
Mailing Address - Phone:205-664-8787
Mailing Address - Fax:
Practice Address - Street 1:2166 PELHAM PARKWAY
Practice Address - Street 2:
Practice Address - City:PELAHM
Practice Address - State:AL
Practice Address - Zip Code:35124
Practice Address - Country:US
Practice Address - Phone:205-664-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
AL362106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist