Provider Demographics
NPI:1659462794
Name:POSTON, TRACI LEIGH (MS, LMHC, CAP)
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:LEIGH
Last Name:POSTON
Suffix:
Gender:F
Credentials:MS, LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 RUSH PARK CIR
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-2405
Mailing Address - Country:US
Mailing Address - Phone:850-581-2884
Mailing Address - Fax:850-581-0408
Practice Address - Street 1:463 RUSH PARK CIR
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-2405
Practice Address - Country:US
Practice Address - Phone:850-581-2884
Practice Address - Fax:850-581-0408
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2047L101YA0400X
FL5485101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761970700Medicaid