Provider Demographics
NPI:1891121844
Name:MARSHALL, TRACEY N (NCC, LPC)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:N
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1142
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39060-1142
Mailing Address - Country:US
Mailing Address - Phone:601-622-6260
Mailing Address - Fax:
Practice Address - Street 1:90 W LAKEVIEW DR.
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5266
Practice Address - Country:US
Practice Address - Phone:166-258-6181
Practice Address - Fax:769-241-0062
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1815101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor