Provider Demographics
NPI:1710309455
Name:KAISER, TRACI LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LEE
Last Name:KAISER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 FM 2616
Mailing Address - Street 2:
Mailing Address - City:HALLETTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77964-5527
Mailing Address - Country:US
Mailing Address - Phone:931-378-3607
Mailing Address - Fax:
Practice Address - Street 1:978 FM 2616
Practice Address - Street 2:
Practice Address - City:HALLETTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77964-5527
Practice Address - Country:US
Practice Address - Phone:931-378-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0099911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical