Provider Demographics
NPI:1821722448
Name:LUDEWIG, TRACY WATFORD (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:WATFORD
Last Name:LUDEWIG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 TIMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-4209
Mailing Address - Country:US
Mailing Address - Phone:979-450-5670
Mailing Address - Fax:
Practice Address - Street 1:600 WEST TIMBERLAND DRIVE
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979
Practice Address - Country:US
Practice Address - Phone:979-450-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YS0200X
TX80881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool