Provider Demographics
NPI:1558069526
Name:SMITH, TRACY SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:SUSAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:SUSAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TRACY LEWIS
Mailing Address - Street 1:PO BOX 1763
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-1763
Mailing Address - Country:US
Mailing Address - Phone:501-593-3202
Mailing Address - Fax:
Practice Address - Street 1:163 PEACEMAKER LN
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-8344
Practice Address - Country:US
Practice Address - Phone:501-593-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical