Provider Demographics
NPI:1891489126
Name:DUBOIS, TRACY (CLC)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 PADDOCK LN
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-4642
Mailing Address - Country:US
Mailing Address - Phone:239-222-5474
Mailing Address - Fax:
Practice Address - Street 1:1100 N BONNIE BRAE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2421
Practice Address - Country:US
Practice Address - Phone:940-312-6577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN