Provider Demographics
NPI:1447602727
Name:SMITH, TRACY H (LPC INTERN)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N COLLINS BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3564
Mailing Address - Country:US
Mailing Address - Phone:972-680-8986
Mailing Address - Fax:972-680-9126
Practice Address - Street 1:1701 N COLLINS BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3564
Practice Address - Country:US
Practice Address - Phone:972-680-8986
Practice Address - Fax:972-680-9126
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69707101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health