Provider Demographics
NPI:1558602698
Name:MILLER-EARL, TRACI DENISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:DENISE
Last Name:MILLER-EARL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2004
Mailing Address - Street 2:
Mailing Address - City:TIOGA
Mailing Address - State:LA
Mailing Address - Zip Code:71477-2004
Mailing Address - Country:US
Mailing Address - Phone:318-269-6675
Mailing Address - Fax:318-708-1013
Practice Address - Street 1:5920 COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3714
Practice Address - Country:US
Practice Address - Phone:318-625-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA110311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical