Provider Demographics
NPI:1558477463
Name:WILLIAMS, TRACY LANE (MA,LPC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LANE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 NOTTINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-4919
Mailing Address - Country:US
Mailing Address - Phone:409-983-7668
Mailing Address - Fax:409-983-4761
Practice Address - Street 1:3747 DOCTOR'S DRIVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642
Practice Address - Country:US
Practice Address - Phone:409-983-7668
Practice Address - Fax:409-983-4761
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional