Provider Demographics
NPI:1639483530
Name:SMITH, TRACY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ROLLING OAKS DR
Mailing Address - Street 2:APT 506
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-5718
Mailing Address - Country:US
Mailing Address - Phone:412-736-0064
Mailing Address - Fax:
Practice Address - Street 1:400 ROLLING OAKS DR
Practice Address - Street 2:APT 506
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-5718
Practice Address - Country:US
Practice Address - Phone:412-736-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70574101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional