Provider Demographics
NPI:1619690369
Name:BRAMLETT, TRACY (LMSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BRAMLETT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:ARETHA
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13031 GORDONS MOTT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5753
Mailing Address - Country:US
Mailing Address - Phone:703-899-5087
Mailing Address - Fax:
Practice Address - Street 1:9939 STATE HIGHWAY 151
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1900
Practice Address - Country:US
Practice Address - Phone:703-899-5087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8678104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker