Provider Demographics
NPI:1679990410
Name:MATCHAM, TRACY (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MATCHAM
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 BLUE CREEK CV
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-0092
Mailing Address - Country:US
Mailing Address - Phone:469-400-2285
Mailing Address - Fax:
Practice Address - Street 1:1105 MEMORIAL DR STE 202
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-2043
Practice Address - Country:US
Practice Address - Phone:903-337-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor