Provider Demographics
NPI:1467011056
Name:POE, TRACI (MA, MCCLC)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:
Last Name:POE
Suffix:
Gender:F
Credentials:MA, MCCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 KEVIN CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4861
Mailing Address - Country:US
Mailing Address - Phone:682-472-7807
Mailing Address - Fax:866-929-1927
Practice Address - Street 1:1716 GRIFFIN LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8560
Practice Address - Country:US
Practice Address - Phone:817-965-5886
Practice Address - Fax:866-929-1927
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker