Provider Demographics
NPI:1609064898
Name:TEW, TRACY (PSYD)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:TEW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 JAN CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016-1632
Mailing Address - Country:US
Mailing Address - Phone:606-854-7130
Mailing Address - Fax:
Practice Address - Street 1:1129 MACKLIND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1440
Practice Address - Country:US
Practice Address - Phone:314-534-0200
Practice Address - Fax:314-534-7996
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2007-59103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist