Provider Demographics
NPI:1710097548
Name:SLOAN, TRACY BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:BETH
Last Name:SLOAN
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 1:8231 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3356
Mailing Address - Country:US
Mailing Address - Phone:210-216-5818
Mailing Address - Fax:210-949-0019
Practice Address - Street 1:8231 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3356
Practice Address - Country:US
Practice Address - Phone:210-216-5818
Practice Address - Fax:210-949-0019
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32025103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0085JNOtherBCBS
TX1576860-01Medicaid
TX1576860-01Medicaid